MODEL RESIDENTIAL HOME INC NPI 1073721288

NPI Information

MODEL RESIDENTIAL HOME, INC is an intermediate care facility mentally retarded in Los Angeles, CA. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. MODEL RESIDENTIAL HOME, INC NPI is 1073721288. The provider is registered as an organization entity type.
The provider Is Doing Business As Laverna Guest Home.

The provider's business location address is:

2227 LAVERNA AVE
LOS ANGELES, CA
ZIP 90041-624
Phone: (323) 254-3621
Fax: (323) 254-3655

The provider's authorized official is Evelyn Moreno .
The authorized official title is Licensee and has the following contact phone number (323) 254-3621.

The enumeration date for this NPI number is 5/19/2007 and was last updated on 6/19/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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