Provider Demographics
NPI:1912225855
Name:SOUTH CENTRAL RESIDENTIAL CARE #2
Entity type:Organization
Organization Name:SOUTH CENTRAL RESIDENTIAL CARE #2
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:THELMA
Authorized Official - Middle Name:ELREAN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:02/10/1947
Authorized Official - Phone:323-233-3553
Mailing Address - Street 1:1551 W 80TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-2839
Mailing Address - Country:US
Mailing Address - Phone:323-233-3553
Mailing Address - Fax:323-231-4544
Practice Address - Street 1:1551 W 80TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-2839
Practice Address - Country:US
Practice Address - Phone:323-233-3553
Practice Address - Fax:323-231-4544
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH CENTRAL RESIDENTIAL CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-15
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA198202126320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness