Provider Demographics
NPI:1659681112
Name:INDEPENDENT LIVING CENTER OF SOUTHERN CALIFORNIA
Entity Type:Organization
Organization Name:INDEPENDENT LIVING CENTER OF SOUTHERN CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:VESCOVO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-785-6934
Mailing Address - Street 1:14407 GILMORE ST
Mailing Address - Street 2:#101
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-1400
Mailing Address - Country:US
Mailing Address - Phone:818-785-6934
Mailing Address - Fax:818-785-0330
Practice Address - Street 1:14407 GILMORE ST
Practice Address - Street 2:#101
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1400
Practice Address - Country:US
Practice Address - Phone:818-785-6934
Practice Address - Fax:818-785-0330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management