Provider Demographics
NPI:1497054761
Name:LAVELLE YOUTH HOMES
Entity Type:Organization
Organization Name:LAVELLE YOUTH HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:
Authorized Official - Last Name:LA VELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-759-2569
Mailing Address - Street 1:8415 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-3044
Mailing Address - Country:US
Mailing Address - Phone:323-759-2569
Mailing Address - Fax:
Practice Address - Street 1:4000 W SLAUSON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-2804
Practice Address - Country:US
Practice Address - Phone:323-759-2569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder