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General NPI Number Information
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NPI Number | 1861842254
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Entity Type | Organization
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Legal Business Name | CHRISTYLZZ PANACEA FOR DESIGN HOME LIVING
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Dates
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Enumeration Date | 06/16/2016
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Last Update Date | 06/16/2016
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Provider Practice Location Address
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Address Line | 7326 S NORMANDIE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90044-2445
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Country | US
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Telephone | 323-473-2381
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Fax |
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Provider Business Mailing Address
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Address Line | 3006 S VERMONT AVE STE 105
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City | LOS ANGELES
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State | CA
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Zip | 90007-3032
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Country | US
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Telephone | 323-531-2050
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | SIBYL CORDELLE CHRISTOPHE
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Credential |
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Telephone | 323-473-2381
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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