Mary's House

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

960000992 Issued in CA

Legal business name

MARY'S HOUSE

Practice address

14901 Condon Ave
Lawndale, CA 90260-1216

Phone

(310) 739-3585

Fax

(310) 675-4551

NPI assigned

May 17, 2007

Last updated

Jul 3, 2008By the provider in NPPES

Organization subpart

Yes

Parent organization

ST. MARY INVESTMENTS, INC.As reported in NPPES

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

Authorized official

Name

Dr. Eugene Hardin, M.D.

Title

Licensee

Phone

(310) 739-3585

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1568679959. Details of each certification follow.

• CCN 55G109 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 55G109

Legal name

MARY'S HOUSE

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

May 27, 1997

Last certification

Dec 31, 2025

Beds

6

Ownership / control type

Private (proprietary)

Facility address

14901 Condon Ave
Lawndale, CA 90260

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

Mary's House

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215043200000",
    "number": "1568679959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14901 CONDON AVE",
            "city": "LAWNDALE",
            "state": "CA",
            "postal_code": "902601216",
            "telephone_number": "310-739-3585",
            "fax_number": "310-675-4551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14901 CONDON AVE",
            "city": "LAWNDALE",
            "state": "CA",
            "postal_code": "902601216",
            "telephone_number": "310-739-3585",
            "fax_number": "310-675-4551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY'S HOUSE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. MARY INVESTMENTS, INC.",
        "enumeration_date": "2007-05-17",
        "last_updated": "2008-07-03",
        "status": "A",
        "authorized_official_last_name": "HARDIN",
        "authorized_official_first_name": "EUGENE",
        "authorized_official_title_or_position": "LICENSEE",
        "authorized_official_telephone_number": "310-739-3585",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "CA",
            "license": "960000992",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL",
            "identifier": "156867995901",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Intellectual Disabilities Intermediate Care Facility in Lawndale, CA
• Providers in Lawndale, CA by specialty
• Intellectual Disabilities Intermediate Care Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.