Healthcare Provider Details

I. General information

NPI: 1528280690
Provider Name (Legal Business Name): LYNWOOD DEVELOPMENTAL CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 W RAYMOND ST
COMPTON CA
90220-4411
US

IV. Provider business mailing address

14925 S ATLANTIC AVE
COMPTON CA
90221-3005
US

V. Phone/Fax

Practice location:
  • Phone: 310-635-5609
  • Fax: 310-223-5921
Mailing address:
  • Phone: 310-223-5920
  • Fax: 310-223-5921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number9601010
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateCA

VIII. Authorized Official

Name: LA VERN L. NEAL
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 310-223-5920