Provider Demographics
NPI:1992266134
Name:DELIANN-LUCILE CORPORATION
Entity type:Organization
Organization Name:DELIANN-LUCILE CORPORATION
Other - Org Name:
Other - Org Type:
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 1:5731 W SLAUSON AVE STE 210
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6982
Practice Address - Country:US
Practice Address - Phone:310-215-8900
Practice Address - Fax:310-215-8907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-29
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children