Organization
HAYNES FAMILY OF PROGRAMS
Active
Other names
LeRoy Haynes Center
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL S. MAYDECK (CHIEF EXECUTIVE OFFICER)
(909) 593-2581
Entity
Organization
Contact information
Practice address
1025 SENTINEL DR, SUITES 200 & 206, LA VERNE, CA 91750-3280
(909) 833-2986
Mailing address
1025 SENTINEL DR, SUITES 200 & 206, LA VERNE, CA 91750-3280
(909) 833-2986
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
000697
CA
252Y00000X
Early Intervention Provider Agency
000697
CA
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
000697
CA
261QM0855X
Adolescent and Children Mental Health Clinic/Center
000697
CA
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
191501972
CA
Other
Enumeration date
09/26/2012
Last updated
08/15/2016
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