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Organization
MODEL RESIDENTIAL HOME, INC.
Active
Organization
MODEL RESIDENTIAL HOME, INC.
Active
Other names
LOLETA GUEST HOME
Organization subpart
No
Provider details
NPI number
Authorized official
EVELYN MORENO R.N. (OWNER/LICENSEE)
(323) 254-3621
Entity
Organization
Contact information
Practice address
5129 LOLETA AVE, LOS ANGELES, CA 90041-1501
(323) 254-3621
(323) 254-3655
Mailing address
1963 LA FREMONTIA ST, SOUTH PASADENA, CA 91030-4226
(323) 254-3621
(323) 254-3655
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Enumeration date
12/09/2011
Last updated
12/09/2011
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