Provider Demographics
NPI:1962664078
Name:THE CELEBRITY CENTER, INC.
Entity type:Organization
Organization Name:THE CELEBRITY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:LOYRANE
Authorized Official - Last Name:STOKES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:213-706-5569
Mailing Address - Street 1:9550 CRENSHAW BLVD
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305-2912
Mailing Address - Country:US
Mailing Address - Phone:213-706-5569
Mailing Address - Fax:323-292-1103
Practice Address - Street 1:4600 DON LORENZO DR APT 19
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-5509
Practice Address - Country:US
Practice Address - Phone:323-294-4424
Practice Address - Fax:323-294-4494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA0600X261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT7945Medicare PIN
CAU52348Medicare UPIN