Organization
LOS ANGELES YOUTH NETWORK
Active
Other names
Hollywood House
Organization subpart
No
Provider details
NPI number
Authorized official
MARK SUPPER (PRESIDENT/CEO)
(323) 467-8466
Entity
Organization
Contact information
Practice address
1719 TAFT AVE, LOS ANGELES, CA 90028-5704
(323) 957-7757
Mailing address
1754 TAFT AVE, LOS ANGELES, CA 90028-5705
(323) 366-2450
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
198208596
CA
Other
Enumeration date
01/04/2017
Last updated
01/06/2017
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