# LEROY HAYNES CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467713743
- **Authorized official:** JENNIFER MOSSON (LICENSED PSYCHIATRIC TECHNICIAN)
- **Authorized official phone:** (909) 592-3281

## Contact information

- **Practice address:** 233 BASELINE RD, LA VERNE, CA 91750-2353
- **Practice address phone:** (909) 593-2581
- **Practice address fax:** (909) 596-3567
- **Mailing address:** 233 BASELINE RD, LA VERNE, CA 91750-2353

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | PT 34218 | CA | Yes |

## Other

- **Enumeration date:** 06/04/2012
- **Last updated:** 06/04/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 7565A | OUTPATIENT MENTAL HEALTH | CA |