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General NPI Number Information
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NPI Number | 1750592127
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Entity Type | Organization
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Legal Business Name | ROSECRANS VILLA INC
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 14110 CORDARY AVE
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City | HAWTHORNE
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State | CA
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Zip | 90250-8005
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Country | US
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Telephone | 310-675-9163
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Fax | 310-676-4388
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Provider Business Mailing Address
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Address Line | 14110 CORDARY AVE
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City | HAWTHORNE
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State | CA
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Zip | 90250-8005
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Country | US
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Telephone | 310-675-9163
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Fax | 310-676-4388
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | MS. TRICIA MARIE PEDROZA
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Credential |
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Telephone | 310-675-9163
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State | CA
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