Provider Demographics
NPI:1649434697
Name:LAVELLE YOUTH HOMES
Entity type:Organization
Organization Name:LAVELLE YOUTH HOMES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAVELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-829-0234
Mailing Address - Street 1:1025 ARROW HIGH WAY
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-5450
Mailing Address - Country:US
Mailing Address - Phone:323-829-0234
Mailing Address - Fax:
Practice Address - Street 1:1025 W ARROW HWY
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-5450
Practice Address - Country:US
Practice Address - Phone:323-829-0234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAVELLE YOUTH HOMES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-17
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center