NPIMap

Organization Active NPI

Los Angeles Youth Network

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Los Angeles, CA
National Provider Identifier
1689119380
Registry record updated Jan 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
198208596 Issued in CA
Legal business name
LOS ANGELES YOUTH NETWORK
Practice address
1719 Taft Ave
Los Angeles, CA 90028-5704
Phone
(323) 957-7757
NPI assigned
Jan 4, 2017
Last updated
Jan 6, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2017

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

Authorized official

Name
Mark Supper
Title
President/Ceo
Phone
(323) 467-8466

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X 198208596 CA Primary

Addresses

Primary practice location

1719 Taft Ave
Los Angeles, CA 90028-5704

Mailing address

1754 Taft Ave
Los Angeles, CA 90028-5705
Phone (323) 366-2450

Other names 1

  • Hollywood House Other name

National Provider Directory

National Provider Directory
Tax ID family
Beachwood House2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1719 Taft Ave
Los Angeles, CA 90028
Phone (323) 467-8466

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1483488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1483660800000",
    "number": "1689119380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1754 TAFT AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900285705",
            "telephone_number": "323-366-2450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1719 TAFT AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900285704",
            "telephone_number": "323-957-7757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOS ANGELES YOUTH NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-04",
        "last_updated": "2017-01-06",
        "status": "A",
        "authorized_official_last_name": "SUPPER",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "323-467-8466"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "CA",
            "license": "198208596",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hollywood House",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2017; 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.