Organization
HAYNES FAMILY OF PROGRAMS
Active
Other names
LeRoy Haynes Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANIEL S. MAYDECK (CHIEF EXECUTIVE OFFICER)
(909) 593-2581
Entity
Organization
Contact information
Practice address
1350 3RD ST, LA VERNE, CA 91750-5201
(909) 593-2581
(909) 596-3567
Mailing address
1350 3RD ST, LA VERNE, CA 91750-5201
(909) 593-2581
(909) 596-3567
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
191501972
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7565A
OUTPATIENT MENTAL HEALTH
CA
Enumeration date
03/21/2007
Last updated
04/12/2021
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