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General NPI Number Information
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NPI Number | 1154259547
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Entity Type | Organization
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Legal Business Name | EMBOLDEN YOUTH SERVICES
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Dates
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Enumeration Date | 05/13/2026
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Last Update Date | 05/13/2026
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Provider Practice Location Address
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Address Line | 643 W 95TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90044-5615
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Country | US
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Telephone | 323-305-3209
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Fax |
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Provider Business Mailing Address
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Address Line | 643 W 95TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90044-5615
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Country | US
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Telephone | 323-305-3209
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. KENDRA BOLDEN
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Credential |
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Telephone | 562-225-4442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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