McLennan Avenue Home

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

Legal business name

MCLENNAN AVENUE HOME

Practice address

12325 McLennan Ave
Granada Hills, CA 91344-1716

Phone

(818) 886-3172

Fax

(747) 300-9108

NPI assigned

May 30, 2018

Organization subpart

No

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

Authorized official

Name

Mr. Roy L Martin II

Title

President

Phone

(323) 253-5316

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 55G800

Legal name

MCLENNAN AVENUE HOME

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Apr 20, 2022

Last certification

Jan 28, 2026

Beds

4

Ownership / control type

Private (non-profit)

Facility address

12325 McLennan Avenue
Granada Hills, CA 91344

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

{
    "created_epoch": "1527638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705363200000",
    "number": "1629560263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12325 MCLENNAN AVE",
            "city": "GRANADA HILLS",
            "state": "CA",
            "postal_code": "913441716",
            "telephone_number": "818-886-3172",
            "fax_number": "747-300-9108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12325 MCLENNAN AVE",
            "city": "GRANADA HILLS",
            "state": "CA",
            "postal_code": "913441716",
            "telephone_number": "818-886-3172",
            "fax_number": "747-300-9108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCLENNAN AVENUE HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-30",
        "last_updated": "2024-01-16",
        "certification_date": "2024-01-16",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "ROY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "323-253-5316",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "II"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mayane Congregate Living
• McBean Enterprises Incorporated
• McBean Enterprises Incorporated
• Rachel McCarthy-Moya
• McCrae & Rodgers
• McLennan Home
• Agnieszka Medina, LCSW
• Rosa Medina
• Cynthia Vanessa Medrano
• Medride Transport, LLC

• Intellectual Disabilities Intermediate Care Facility in Granada Hills, CA
• Providers in Granada Hills, 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 Jan 16, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.