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NPI Code Detail

MEDICARE: EMBOLDEN YOUTH SERVICES

MEDICARE: EMBOLDEN YOUTH SERVICES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
3320800000XMental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number : 1154259547
Entity Type Code : Organization
Provider Name (Legal Business Name) : EMBOLDEN YOUTH SERVICES
Provider Business Mailing Address
First Line : 643 W 95TH ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90044-5615
Country : US
Telephone Number : 323-305-3209
Fax Number :
Provider Business Practice Location Address
First Line : 643 W 95TH ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90044-5615
Country : US
Telephone Number : 323-305-3209
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MRS. KENDRA BOLDEN
Credential :
Telephone Number : 562-225-4442
Provider Enumeration Date : 05/13/2026
Last Update Date : 05/13/2026

Similar Medicare Providers

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Practice Fax:
1992820575 — ALEXANDER L. AUNG SOCIAL WORKER
Practice Location Address:
1325 N WESTERN AVE
LOS ANGELES, CA
90027-5615
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Practice Fax:
1639294770 — MR. DANIEL MARK BALLIN LCSW
Practice Location Address:
1325 N WESTERN AVE
LOS ANGELES, CA
90027-5615
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Practice Fax: 323-957-7419
1619096674 — SHANNON FERGUSON
Practice Location Address:
1325 N WESTERN AVE
LOS ANGELES, CA
90027-5615
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Practice Fax:

Directions to “EMBOLDEN YOUTH SERVICES ” Practice Location

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