Provider Demographics
NPI:1306395454
Name:DELIANN-LUCILE
Entity Type:Organization
Organization Name:DELIANN-LUCILE
Other - Org Name:DELILU ACHIEVEMENT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-215-8900
Mailing Address - Street 1:5800 HANNUM AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6553
Mailing Address - Country:US
Mailing Address - Phone:310-215-8900
Mailing Address - Fax:310-215-8907
Practice Address - Street 1:5800 HANNUM AVE STE 230
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90230-6553
Practice Address - Country:US
Practice Address - Phone:310-837-5494
Practice Address - Fax:310-815-8601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-30
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA198203559322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children