Organization · Type 2 NPI

Eggleston Youth Centers, Inc.

Emotionally Disturbed Childrens' Residential Treatment Facility · Pomona, CA

NPI number 1689111809 Active

Practice location

215 W La Verne Ave
Pomona, CA 91767-2333

Call (626) 480-8107 Map

Fax (626) 869-0280

Mailing address

13001 Ramona Blvd Ste E
Irwindale, CA 91706-3752

Specialties and licenses

Taxonomy	Code	License
Adolescent and Children Mental Health Clinic/Center	261QM0855X	None listed
Emotionally Disturbed Childrens' Residential Treatment Facility Primary	322D00000X	LCSW (CA)

Emotionally Disturbed Childrens' Residential Treatment Facility: A residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral issues, and intellectual disabilities and are not able to live independently.

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NPI record

NPI: 1689111809
Entity type: Organization (Type 2)
Issued: Jan 25, 2017
Last updated: Oct 2, 2018
Status: Active
Subpart: Yes of Eggleston Youth Centers, Inc.

Other names

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Eggleston BHS - la Verne · other name

Authorized official

Cassandra Elaine Gibson-Judkins, LCSW
Assistant Executive Director
(626) 480-8107

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1689111809

Eggleston Youth Centers, Inc.'s National Provider Identifier is 1689111809, issued on Jan 25, 2017. The primary taxonomy on file is Emotionally Disturbed Childrens' Residential Treatment Facility (322D00000X), and the practice location is in Pomona, CA. The record was last updated on Oct 2, 2018.