MODEL RESIDENTIAL HOME, INC. (NPI# 1356619019) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356619019 |
| Entity Type | Organization |
| Organization Name | MODEL RESIDENTIAL HOME, INC. |
| Other Organization Name | LOLETA GUEST HOME |
| Practice Address |
5129 Loleta Ave Los Angeles CA 90041-1501 |
| Mailing Address |
1963 La Fremontia St South Pasadena CA 91030-4226 |
| Practice Telephone | 3232543621 |
| Practice Fax Number | 3232543655 |
| Mailing Telephone | 3232543621 |
| Mailing Fax Number | 3232543655 |
| Enumeration Date | 2011-12-09 |
| Last Update Date | 2011-12-09 |
| Authorized Official Name | EVELYN MORENO (OWNER/LICENSEE) |
| Authorized Official Telephone | 3232543621 |
| Authorized Official Credential | R.N. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| LOLETA GUEST HOME | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427322304 | Model Residential Home, Inc. | Intermediate Care Facility, Mentally Retarded | 1621 Linda Rosa Ave, Los Angeles, CA 90041-2225 | 2012-02-24 |
| Street Address |
5129 LOLETA AVE |
| City | LOS ANGELES |
| State | CA |
| Zip Code | 90041-1501 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457994501 | Josephine Villanueva | Technician | 4433 Eagle Rock Blvd. #113, Los Angeles, CA 90041 | 2019-10-22 |
| 1457862484 | Maria Susana Espino Gonzales | Physiological Laboratory | 5264 Lockhaven Ave, Los Angeles, CA 90041 | 2017-10-17 |
| 1407366602 | Tuan H Phan | Pharmacist | 4414 Yolk Boulevard, Los Angeles, CA 90041 | 2017-10-03 |
| 1194195164 | College Vista, LLC | Skilled Nursing Facility | 4681 North Eagle Rock Blvd, Los Angeles, CA 90041 | 2015-10-02 |
| 1346640026 | Angelynn Hermes | Social Worker | 850 Colorado Blvd Ste 102, Los Angeles, CA 90041 | 2014-08-29 |
| 1205181179 | Michael E Ignacio | Dentist | 1916 W. Colorado, Los Angeles, CA 90041 | 2012-07-17 |
| 1093074999 | Marilyn Henry Murphy | Psychologist | 4368 Eagle Rock Boulevard, Los Angeles, CA 90041 | 2012-05-11 |
| 1235434911 | Mohammad Khaknegar | Dentist | 2455 Colorado Blvd., #16, Los Angeles, CA 90041 | 2011-01-11 |
| 1174844088 | Ileana Escobedo | Marriage & Family Therapist | 1551 Waldran Ave, Los Angeles, CA 90041 | 2010-06-15 |
| 1649404963 | Metro Healthcare Medical Supply, LLC | Durable Medical Equipment & Medical Supplies | 4515 Eagle Rock Blvd., Ste 111-c, Los Angeles, CA 90041 | 2009-05-14 |
| Find all providers in zip 90041 | ||||
| Taxonomy Code | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mentally Retarded |
| (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427322304 | Model Residential Home, Inc. | Intermediate Care Facility, Mentally Retarded | 1621 Linda Rosa Ave, Los Angeles, CA 90041-2225 | 2012-02-24 |
| 1417121310 | Temple Garden Homes for The Developmentally Disabled, Inc | Intermediate Care Facility, Mentally Retarded | 4675 York Blvd, Los Angeles, CA 90041-3342 | 2008-04-22 |
| 1063621126 | Caridean, Inc. | Intermediate Care Facility, Mentally Retarded | 1942 Thoreau St, Los Angeles, CA 90047-4725 | 2007-05-22 |
| 1174731384 | Caridean Place | Intermediate Care Facility, Mentally Retarded | 1948 Thoreau St, Los Angeles, CA 90047-4725 | 2007-05-19 |
| 1992913107 | Joyce Marie Home, Inc | Intermediate Care Facility, Mentally Retarded | 2839 S Holt Ave, Los Angeles, CA 90034-2510 | 2007-05-19 |
| 1346458569 | Jasmine Centers, Inc. | Intermediate Care Facility, Mentally Retarded | 3846 Chanson Dr, Los Angeles, CA 90043-1602 | 2007-05-19 |
| 1700094919 | Caridean, Inc. | Intermediate Care Facility, Mentally Retarded | 8630 Rayford Dr, Los Angeles, CA 90045-3512 | 2007-05-19 |
| 1073721288 | Model Residential Home, Inc | Intermediate Care Facility, Mentally Retarded | 2227 Laverna Ave, Los Angeles, CA 90041-2624 | 2007-05-19 |
| 1528276730 | Ebora Guest Home | Intermediate Care Facility, Mentally Retarded | 355 S Kingsley Dr, Los Angeles, CA 90020-3409 | 2007-05-19 |
| 1679788566 | J-j Qual Care Home | Intermediate Care Facility, Mentally Retarded | 1306 S Hudson Ave, Los Angeles, CA 90019-3013 | 2007-05-13 |
| Find all providers in LOS ANGELES | ||||
| City | LOS ANGELES |
| Zip Code | 90041 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.