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General NPI Number Information
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NPI Number | 1154542694
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Entity Type | Organization
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Legal Business Name | LYNWOOD DEVELOPMENTAL CARE, INC
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 709 W RAYMOND ST
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City | COMPTON
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State | CA
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Zip | 90220-4411
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Country | US
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Telephone | 310-632-7216
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Fax | 310-223-5921
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Provider Business Mailing Address
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Address Line | 14925 S ATLANTIC AVE
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City | COMPTON
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State | CA
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Zip | 90221-3005
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Country | US
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Telephone | 310-223-5920
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Fax | 310-223-5921
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | LA VERN L. NEAL
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Credential |
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Telephone | 310-223-5920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State | CA
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