Organization · NPI-2

Caridean Place

Intermediate Care Facility, Intellectual Disabilities · Los Angeles, CA

NPI number1174731384
StatusActive
Last updated in NPPESAug 22, 2020

Details

NPI
1174731384
Entity type
Organization (NPI-2)
Legal business name
Caridean Place
Organization subpart
No
Enumeration date
May 19, 2007
Last updated
Aug 22, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
315P00000X Intermediate Care Facility, Intellectual Disabilities960000761CAYes

Practice location

1948 Thoreau St
Los Angeles, CA 90047-4725

Phone 323-770-2051 · Fax 323-779-3615

Mailing address

1948 Thoreau St
Los Angeles, CA 90047-4725

Phone 323-770-2051

Authorized official

Carrie Griffis
Licensee
3237702051

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