NPIMap

Organization Active NPI

Haynes Family of Programs

  • Mental Illness Community Based Residential Treatment Facility
  • La Verne, CA
National Provider Identifier
1164548236
Registry record updated Apr 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
191501972 Issued in CA
Legal business name
HAYNES FAMILY OF PROGRAMS
Practice address
1350 3Rd St
La Verne, CA 91750-5201
Phone
(909) 593-2581
Fax
(909) 596-3567
NPI assigned
Mar 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2021

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

Authorized official

Name
Mr. Daniel S. Maydeck
Title
Chief Executive Officer
Phone
(909) 593-2581

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193200000X MULTI-SPECIALTY GROUP 103K00000X
Mental Illness Community Based Residential Treatment Facility 320800000X 191501972 CA Primary

Addresses

Primary practice location

1350 3Rd St
La Verne, CA 91750-5201

Mailing address

1350 3Rd St
La Verne, CA 91750-5201
Phone (909) 593-2581

Other practice location 1

1025 Sentinel Dr Ste 200 & 206
LA Verne, CA 91750-3282
Phone (909) 833-2986

Other identifiers 1

IdentifierTypeStateIssuer
7565AOtherCAOUTPATIENT MENTAL HEALTH

Other names 1

  • LeRoy Haynes Center Other name

National Provider Directory

National Provider Directory
Tax ID family
Haynes Family of Programs4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

1025 Sentinel Dr
La Verne, CA 91750
Phone (909) 593-2581

1025 Sentinel Dr
Ste 200206
La Verne, CA 91750

1025 Sentinel Dr
Ste 200
La Verne, CA 91750
Phone (909) 833-2986

Practitioners & affiliated clinicians

Practitioners 32

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618185600000",
    "number": "1164548236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1350 3RD ST",
            "city": "LA VERNE",
            "state": "CA",
            "postal_code": "917505201",
            "telephone_number": "909-593-2581",
            "fax_number": "909-596-3567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 3RD ST",
            "city": "LA VERNE",
            "state": "CA",
            "postal_code": "917505201",
            "telephone_number": "909-593-2581",
            "fax_number": "909-596-3567"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1025 Sentinel Dr Ste 200 & 206",
            "address_purpose": "LOCATION",
            "city": "LA Verne",
            "state": "CA",
            "postal_code": "917503282",
            "country_code": "US",
            "telephone_number": "909-833-2986",
            "fax_number": "909-614-7466",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "HAYNES FAMILY OF PROGRAMS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-21",
        "last_updated": "2021-04-12",
        "certification_date": "2021-04-12",
        "status": "A",
        "authorized_official_last_name": "MAYDECK",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "909-593-2581",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "CA",
            "license": "191501972",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OUTPATIENT MENTAL HEALTH",
            "identifier": "7565A",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LeRoy Haynes Center",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "LeRoy Haynes Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in La Verne, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.