Healthcare Provider Details

I. General information

NPI: 1922893320
Provider Name (Legal Business Name): DYLETTE FAMILY FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1946 RIDGEGATE LN APT L
SIMI VALLEY CA
93065-2959
US

IV. Provider business mailing address

PO BOX 940531
SIMI VALLEY CA
93094-0531
US

V. Phone/Fax

Practice location:
  • Phone: 805-328-0990
  • Fax:
Mailing address:
  • Phone: 805-328-0980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: HOWAR DAVIS
Title or Position: FOUNDER
Credential:
Phone: 805-328-0980