Dalton Avenue Homes, Inc. - Loop II

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

Legal business name

DALTON AVENUE HOMES, INC. - LOOP II

Practice address

15918 S Dalton Ave
Gardena, CA 90247-3908

Phone

(310) 630-0636

Fax

(310) 808-0883

NPI assigned

May 19, 2007

Organization subpart

No

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

Authorized official

Name

Tony Dojcinovic

Title

Licensee

Phone

(310) 808-0883

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 55G259

Legal name

LOOP HOME FOUNDATION, INC II

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Jul 3, 1999

Last certification

Oct 7, 2025

Beds

6

Ownership / control type

Other (specify)

Facility address

15918 Dalton St
Gardena, CA 90247

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

{
    "created_epoch": "1179532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1659589869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15920 S DALTON AVE",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902473908",
            "telephone_number": "310-808-0883",
            "fax_number": "310-808-0883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15918 S DALTON AVE",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902473908",
            "telephone_number": "310-630-0636",
            "fax_number": "310-808-0883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DALTON AVENUE HOMES, INC. - LOOP II",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DOJCINOVIC",
        "authorized_official_first_name": "TONY",
        "authorized_official_title_or_position": "LICENSEE",
        "authorized_official_telephone_number": "310-808-0883"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual Disabilities Intermediate Care Facility in Gardena, CA
• Providers in Gardena, 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 Aug 22, 2020; 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.