Organization
LEROY HAYNES CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER MOSSON (LICENSED PSYCHIATRIC TECHNICIAN)
(909) 592-3281
Entity
Organization
Contact information
Practice address
233 BASELINE RD, LA VERNE, CA 91750-2353
(909) 593-2581
(909) 596-3567
Mailing address
233 BASELINE RD, LA VERNE, CA 91750-2353
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
PT 34218
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7565A
OUTPATIENT MENTAL HEALTH
CA
Enumeration date
06/04/2012
Last updated
06/04/2012
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