Provider Demographics
NPI:1407972714
Name:LAVELLE YOUTH HOMES
Entity Type:Organization
Organization Name:LAVELLE YOUTH HOMES
Other - Org Name:THE LAVELLE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-677-2569
Mailing Address - Street 1:652 E MANCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1910
Mailing Address - Country:US
Mailing Address - Phone:310-677-2569
Mailing Address - Fax:310-677-9429
Practice Address - Street 1:652 E MANCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1910
Practice Address - Country:US
Practice Address - Phone:310-677-2569
Practice Address - Fax:310-677-9429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7132OtherMEDI-CAL PROVIDER NUMBER