Healthcare Provider Details

I. General information

NPI: 1689302812
Provider Name (Legal Business Name): EAST LOS ANGELES REMARKABLE CITZENS' ASSOCIATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3839 SELIG PL
LOS ANGELES CA
90031-3143
US

IV. Provider business mailing address

3839 SELIG PL
LOS ANGELES CA
90031-3143
US

V. Phone/Fax

Practice location:
  • Phone: 323-223-3079
  • Fax: 323-223-4684
Mailing address:
  • Phone: 323-223-3079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KARINA ALICIA ANDRADE
Title or Position: VICE PRESIDENT
Credential:
Phone: 323-718-7676