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General NPI Number Information
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NPI Number | 1932317146
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Entity Type | Organization
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Legal Business Name | LA CASA
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Dates
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Enumeration Date | 05/19/2007
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 15333 DAPHNE AVE
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City | GARDENA
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State | CA
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Zip | 90249-4123
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Country | US
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Telephone | 310-327-7798
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Fax | 310-327-7715
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Provider Business Mailing Address
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Address Line | PO BOX 513745
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City | LOS ANGELES
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State | CA
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Zip | 90051-1745
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Country | US
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Telephone | 310-266-7380
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Fax | 310-327-7715
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Authorized Official
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Title or Position | LICENSEE
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Name | JULIET DANIELS
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Credential |
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Telephone | 310-266-7380
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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 | 960001099
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License Number State | CA
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