Provider Demographics
NPI:1922548932
Name:DELIANN-LUCILE CORPORATION
Entity Type:Organization
Organization Name:DELIANN-LUCILE CORPORATION
Other - Org Name:DELILU ACHIEVEMENT HOME 1
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
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 1:5731 W SLAUSON AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6982
Mailing Address - Country:US
Mailing Address - Phone:310-215-8900
Mailing Address - Fax:310-215-8907
Practice Address - Street 1:1564 W 36TH PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-4503
Practice Address - Country:US
Practice Address - Phone:323-766-9415
Practice Address - Fax:323-766-1710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-24
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children