Organization · Type 2 NPI

Eggleston Youth Centers, Inc.

Emotionally Disturbed Childrens' Residential Treatment Facility · West Covina, CA

NPI number 1972040194 Active

Practice location

1526 S St Malo St
West Covina, CA 91790-4836

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	197806374 (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.

Another provider at this address

Kaiameka BrownRehabilitation Practitioner West Covina, CA NPI 1437780780

Other emotionally disturbed childrens' residential treatment facility providers in West Covina

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NPI record

NPI: 1972040194
Entity type: Organization (Type 2)
Issued: Jan 25, 2017
Last updated: Apr 25, 2018
Status: Active
Subpart: Yes of Eggleston Youth Centers, Inc.

Other names

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Eggleston BHS - West Covina · other name
Eggleston BHS - West Covina · 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 1972040194

Eggleston Youth Centers, Inc.'s National Provider Identifier is 1972040194, issued on Jan 25, 2017. The primary taxonomy on file is Emotionally Disturbed Childrens' Residential Treatment Facility (322D00000X), and the practice location is in West Covina, CA. The record was last updated on Apr 25, 2018.