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General NPI Number Information
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NPI Number | 1497054761
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Entity Type | Organization
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Legal Business Name | LAVELLE YOUTH HOMES
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Dates
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Enumeration Date | 03/25/2011
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Last Update Date | 03/25/2011
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Provider Practice Location Address
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Address Line | 4000 W SLAUSON AVE
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City | LOS ANGELES
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State | CA
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Zip | 90043-2804
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Country | US
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Telephone | 323-759-2569
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Fax |
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Provider Business Mailing Address
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Address Line | 8415 S WESTERN AVE
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City | LOS ANGELES
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State | CA
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Zip | 90047-3044
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Country | US
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Telephone | 323-759-2569
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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 | MISS TRACI LA VELLE
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Credential |
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Telephone | 323-759-2569
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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