NPIMap

Organization Active NPI

Leroy Haynes Center

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • La Verne, CA
National Provider Identifier
1467713743
Registry record updated Jun 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
PT 34218 Issued in CA
Legal business name
LEROY HAYNES CENTER
Practice address
233 Baseline Rd
La Verne, CA 91750-2353
Phone
(909) 593-2581
Fax
(909) 596-3567
NPI assigned
Jun 4, 2012
Last updated
Jun 4, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2012

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

Authorized official

Name
Jennifer MossonNPI 1235492612
Title
Licensed Psychiatric Technician
Phone
(909) 592-3281

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X PT 34218 CA Primary

Addresses

Primary practice location

233 Baseline Rd
La Verne, CA 91750-2353

Mailing address

233 Baseline Rd
La Verne, CA 91750-2353

Other identifiers 1

IdentifierTypeStateIssuer
7565AOtherCAOUTPATIENT MENTAL HEALTH

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.

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1338768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338768000000",
    "number": "1467713743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "233 BASELINE RD",
            "city": "LA VERNE",
            "state": "CA",
            "postal_code": "917502353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "233 BASELINE RD",
            "city": "LA VERNE",
            "state": "CA",
            "postal_code": "917502353",
            "telephone_number": "909-593-2581",
            "fax_number": "909-596-3567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEROY HAYNES CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-04",
        "last_updated": "2012-06-04",
        "status": "A",
        "authorized_official_last_name": "MOSSON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "LICENSED PSYCHIATRIC TECHNICIAN",
        "authorized_official_telephone_number": "909-592-3281"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "CA",
            "license": "PT 34218",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OUTPATIENT MENTAL HEALTH",
            "identifier": "7565A",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Jun 4, 2012; 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.