NPIMap

Organization Active NPI

Model Residential Home, Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • Los Angeles, CA
National Provider Identifier
1356619019
Registry record updated Dec 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
MODEL RESIDENTIAL HOME, INC.
Practice address
5129 Loleta Ave
Los Angeles, CA 90041-1501
Phone
(323) 254-3621
Fax
(323) 254-3655
NPI assigned
Dec 9, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2011

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

Authorized official

Name
Evelyn Moreno, R.N.
Title
Owner/Licensee
Phone
(323) 254-3621

Specialties & licenses 1

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

Addresses

Primary practice location

5129 Loleta Ave
Los Angeles, CA 90041-1501

Mailing address

1963 La Fremontia St
South Pasadena, CA 91030-4226
Phone (323) 254-3621

Other names 1

  • LOLETA 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 55G691

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
LOLETA GUEST HOME, ICF-DDN
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Dec 21, 2012
Last certification
Feb 5, 2026
Beds
6
Ownership / control type
Other (specify)
Facility address
5129 Loleta 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": "1323388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323388800000",
    "number": "1356619019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1963 LA FREMONTIA ST",
            "city": "SOUTH PASADENA",
            "state": "CA",
            "postal_code": "910304226",
            "telephone_number": "323-254-3621",
            "fax_number": "323-254-3655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5129 LOLETA AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900411501",
            "telephone_number": "323-254-3621",
            "fax_number": "323-254-3655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODEL RESIDENTIAL HOME, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-09",
        "last_updated": "2011-12-09",
        "status": "A",
        "authorized_official_last_name": "MORENO",
        "authorized_official_first_name": "EVELYN",
        "authorized_official_title_or_position": "OWNER/LICENSEE",
        "authorized_official_telephone_number": "323-254-3621",
        "authorized_official_credential": "R.N."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LOLETA GUEST HOME",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.