Provider Demographics
NPI:1992967129
Name:LOVE AND RESPECT YOUTH FOUNDATION
Entity type:Organization
Organization Name:LOVE AND RESPECT YOUTH FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT OF RECORD
Authorized Official - Prefix:MS
Authorized Official - First Name:KORESHA
Authorized Official - Middle Name:BABETTE
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-293-7805
Mailing Address - Street 1:4728 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90062-2320
Mailing Address - Country:US
Mailing Address - Phone:323-293-7388
Mailing Address - Fax:
Practice Address - Street 1:4728 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90062-2320
Practice Address - Country:US
Practice Address - Phone:323-293-7388
Practice Address - Fax:323-293-7805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X, 251S00000X
251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty