Basic Information
| Provider Information | |||||||||
| NPI: | 1861791139 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAVELLE YOUTH HOMES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8415 S WESTERN AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900473044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237592569 | ||||||||
| FaxNumber: | 3237599425 | ||||||||
| Practice Location | |||||||||
| Address1: | 7400 W MANCHESTER AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900452322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237592569 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2011 | ||||||||
| LastUpdateDate: | 03/25/2011 | ||||||||
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| AuthorizedOfficialLastName: | LA VELLE | ||||||||
| AuthorizedOfficialFirstName: | TRACI | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3237592569 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No ID Information.