NPIMap

Organization Active NPI

San Gabriel Childrens Center Inc.

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Azusa, CA
National Provider Identifier
1205384559
Registry record updated May 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
Legal business name
SAN GABRIEL CHILDRENS CENTER INC.
Practice address
5329 N Homerest Ave
Azusa, CA 91702-5429
Phone
(626) 859-2089
Fax
(626) 859-6537
NPI assigned
Sep 15, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2024

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

Authorized official

Name
Mr. Porfirio Rincon
Title
Ceo
Phone
(626) 859-2089

Specialties & licenses 1

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

Addresses

Primary practice location

5329 N Homerest Ave
Azusa, CA 91702-5429

Mailing address

1211 Center Court Dr Ste 105
Covina, CA 91724-3613
Phone (626) 859-2089

Other identifiers 1

IdentifierTypeStateIssuer
0000056BJMedicaidCA

Other names 1

  • SGCC-Homerest Home Other name

National Provider Directory

National Provider Directory
Tax ID family
San Gabriel Children'S Center Inc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

1211 Center Court Dr
Ste 105
Covina, CA 91724

NPI Registry JSON

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

{
    "created_epoch": "1473897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714521600000",
    "number": "1205384559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1211 CENTER COURT DR STE 105",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917243613",
            "telephone_number": "626-859-2089",
            "fax_number": "626-859-6537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5329 N HOMEREST AVE",
            "city": "AZUSA",
            "state": "CA",
            "postal_code": "917025429",
            "telephone_number": "626-859-2089",
            "fax_number": "626-859-6537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN GABRIEL CHILDRENS CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-15",
        "last_updated": "2024-05-01",
        "certification_date": "2024-05-01",
        "status": "A",
        "authorized_official_last_name": "RINCON",
        "authorized_official_first_name": "PORFIRIO",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "626-859-2089",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0000056BJ",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SGCC-Homerest Home",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "SGCC-Homerest Home",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Azusa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2024; 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.