L. Marillac Group Home

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

Legal business name

L. MARILLAC GROUP HOME

Practice address

23711 Prospect Valley Dr
Diamond Bar, CA 91765-1637

Phone

(909) 821-3698

Fax

(909) 860-7614

NPI assigned

May 19, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Grace Villegas

Title

Licensee

Phone

(909) 821-3698

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1679781884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23711 PROSPECT VALLEY DR",
            "city": "DIAMOND BAR",
            "state": "CA",
            "postal_code": "917651637",
            "telephone_number": "909-821-3698",
            "fax_number": "909-860-7614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23711 PROSPECT VALLEY DR",
            "city": "DIAMOND BAR",
            "state": "CA",
            "postal_code": "917651637",
            "telephone_number": "909-821-3698",
            "fax_number": "909-860-7614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "L. MARILLAC GROUP HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "VILLEGAS",
        "authorized_official_first_name": "GRACE",
        "authorized_official_title_or_position": "LICENSEE",
        "authorized_official_telephone_number": "909-821-3698"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jaymee Kwan, FNP
• Michael Lawrence Kwok, M.D.
• Bryan Kwon, DPT
• Ojin Kwon, D.D.S.
• Christine Kwong
• La Vista Health (La Vista Health Center)
• Amanda La, O.D.
• Laboratory Corporation of America
• Chenyu Lai III, D.D.S.
• Kevin Lai, D.D.S.

• Intellectual Disabilities Intermediate Care Facility in Diamond Bar, CA
• Providers in Diamond Bar, CA by specialty
• Intellectual Disabilities Intermediate Care Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.