MEDICARE: DYLETTE FAMILY FOUNDATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	172V00000X	Community Health Worker
2	3245S0500X	Children's Substance Abuse Rehabilitation Facility
3	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1922893320
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYLETTE FAMILY FOUNDATION

Provider Business Mailing Address
First Line	:	PO BOX 940531
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93094-0531
Country	:	US
Telephone Number	:	805-328-0980
Fax Number	:

Provider Business Practice Location Address
First Line	:	1946 RIDGEGATE LN APT L
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-2959
Country	:	US
Telephone Number	:	805-328-0990
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	HOWAR DAVIS
Credential	:
Telephone Number	:	805-328-0980

Provider Enumeration Date	:	04/14/2025
Last Update Date	:	04/14/2025

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Directions to “DYLETTE FAMILY FOUNDATION ” Practice Location

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