Organization
MODEL RESIDENTIAL HOME, INC
Active
Other names
Laverna Guest Home
Organization subpart
No
Provider details
NPI number
Authorized official
EVELYN MORENO (LICENSEE)
(323) 254-3621
Entity
Organization
Contact information
Practice address
2227 LAVERNA AVE, LOS ANGELES, CA 90041-2624
(323) 254-3621
(323) 254-3655
Mailing address
2227 LAVERNA AVE, LOS ANGELES, CA 90041-2624
(323) 254-3621
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
960001042
CA
Other
Enumeration date
05/19/2007
Last updated
06/19/2008
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