Healthcare Provider Details

I. General information

NPI: 1962664078
Provider Name (Legal Business Name): THE CELEBRITY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 DON LORENZO DR APT 19
LOS ANGELES CA
90008-5509
US

IV. Provider business mailing address

9550 CRENSHAW BLVD
INGLEWOOD CA
90305-2912
US

V. Phone/Fax

Practice location:
  • Phone: 323-294-4424
  • Fax: 323-294-4494
Mailing address:
  • Phone: 213-706-5569
  • Fax: 323-292-1103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number261QA0600X
License Number StateCA

VIII. Authorized Official

Name: DR. YVONNE LOYRANE STOKES
Title or Position: C.E.O.
Credential: D.C.
Phone: 213-706-5569