NPIMap

Organization Active NPI

Model Residential Home, Inc

Doing business as Laverna Guest Home

  • Intellectual Disabilities Intermediate Care Facility
  • Los Angeles, CA
National Provider Identifier
1073721288
Registry record updated Jun 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
960001042 Issued in CA
Legal business name
MODEL RESIDENTIAL HOME, INC
Doing business as
Laverna Guest Home
Practice address
2227 Laverna Ave
Los Angeles, CA 90041-2624
Phone
(323) 254-3621
Fax
(323) 254-3655
NPI assigned
May 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Evelyn Moreno
Title
Licensee
Phone
(323) 254-3621

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 960001042 CA Primary

Addresses

Primary practice location

2227 Laverna Ave
Los Angeles, CA 90041-2624

Mailing address

2227 Laverna Ave
Los Angeles, CA 90041-2624
Phone (323) 254-3621

Other names 1

  • Laverna Guest Home Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 55G224

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
LAVERNA GUEST HOME
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Nov 23, 1998
Last certification
Dec 10, 2025
Beds
6
Ownership / control type
Private (proprietary)
Facility address
2227 Laverna Avenue
Los Angeles, CA 90041

National Provider Directory

National Provider Directory
Tax ID family
Laverna Guest Home3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213833600000",
    "number": "1073721288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2227 LAVERNA AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900412624",
            "telephone_number": "323-254-3621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2227 LAVERNA AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900412624",
            "telephone_number": "323-254-3621",
            "fax_number": "323-254-3655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODEL RESIDENTIAL HOME, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-19",
        "last_updated": "2008-06-19",
        "status": "A",
        "authorized_official_last_name": "MORENO",
        "authorized_official_first_name": "EVELYN",
        "authorized_official_title_or_position": "LICENSEE",
        "authorized_official_telephone_number": "323-254-3621"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "CA",
            "license": "960001042",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Laverna Guest Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.