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General NPI Number Information
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NPI Number | 1447468657
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Entity Type | Organization
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Legal Business Name | MARIE'S PRIVATE QUARTERS
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Dates
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Enumeration Date | 05/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2512 W 134TH PL
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City | GARDENA
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State | CA
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Zip | 90249-1646
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Country | US
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Telephone | 310-532-4288
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Fax | 310-532-6204
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Provider Business Mailing Address
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Address Line | 2512 W 134TH PL
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City | GARDENA
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State | CA
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Zip | 90249-1646
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Country | US
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Telephone | 310-532-4288
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Fax |
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Authorized Official
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Title or Position | LICENSEE
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Name | NELMA MARIE MITCHELL
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Credential |
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Telephone | 310-532-4288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State | CA
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