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General NPI Number Information
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NPI Number | 1891830964
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Entity Type | Organization
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Legal Business Name | EAST LOS ANGELES REMARKABLE CITIZEN ASSN
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 15576 LUJON ST
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City | HACIENDA HEIGHTS
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State | CA
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Zip | 91745
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Country | US
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Telephone | 626-333-7554
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Fax |
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Provider Business Mailing Address
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Address Line | 3839 SELIG PLACE
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City | LOS ANGELES
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State | CA
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Zip | 90031
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Country | US
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Telephone | 323-223-3079
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Fax | 323-223-4684
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Authorized Official
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Title or Position | CEO PRESIDENT ADMINISTRATOR
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Name | MR. CARLOS E MADRID
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Credential | MSW MPA
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Telephone | 323-223-3079
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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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