L. Marillac Group Home
NPI #1679781884 in Diamond Bar, California
Provider Information
- NPI Number
- 1679781884
- Entity Type
- Organization
- Organization Name
- L. Marillac Group Home
- Primary Specialty
- Intermediate Care Facility, Intellectual Disabilities
- Enumeration Date
- May 19, 2007
- Last Updated
- Aug 22, 2020
Practice Location
- Address
- 23711 PROSPECT VALLEY DR
- City
- Diamond Bar
- State
- California
- ZIP Code
- 91765-1637
- Phone
- (909) 821-3698
Authorized Official
- Name
- GRACE VILLEGAS
- Title
- LICENSEE
- Phone
- (909) 821-3698
Specialties & Taxonomy Codes
| Specialty |
|---|
| Intermediate Care Facility, Intellectual Disabilities |
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