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General NPI Number Information
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NPI Number | 1326241332
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Entity Type | Organization
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Legal Business Name | MAGIC CIRCLE ADULT DAY HEALTH CARE CENTER INC.
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 08/14/2007
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Provider Practice Location Address
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Address Line | 105 S PRAIRIE AVE
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City | INGLEWOOD
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State | CA
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Zip | 90301-1969
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Country | US
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Telephone | 310-674-8345
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Fax |
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Provider Business Mailing Address
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Address Line | 105 S PRAIRIE AVE
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City | INGLEWOOD
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State | CA
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Zip | 90301-1969
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Country | US
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Telephone | 310-674-8345
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. FAYE ANNETTE WILLIAMS
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Credential | PH.D.
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Telephone | 310-674-8345
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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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