NPIMap

Organization Active NPI

Boys Republic

  • Mental Illness Community Based Residential Treatment Facility
  • Pomona, CA
National Provider Identifier
1215489000
Registry record updated Nov 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
BOYS REPUBLIC
Practice address
733 N Garey Ave
Pomona, CA 91767
Phone
(909) 622-3556
Fax
(909) 306-5427
NPI assigned
Oct 27, 2016
Organization subpart
Yes
Parent organization
BOYS REPUBLICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 30, 2022

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

Authorized official

Name
Bayley Dark, LCSW
Title
Clinician/Head of Service
Phone
(909) 536-6611

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X
Mental Illness Community Based Residential Treatment Facility 320800000X Primary

Addresses

Primary practice location

733 N Garey Ave
Pomona, CA 91767

Mailing address

1907 Boys Republic Dr
Chino Hills, CA 91709-5447
Phone (909) 628-1217

Other names 1

  • Boys Republic - Pomona Residence Other name

National Provider Directory

National Provider Directory
Tax ID family
Boys Republic11 organizations share this tax ID, including this one
Part of
Boys Republic

Other organizations with this tax ID 10

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

NPI Registry JSON

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

{
    "created_epoch": "1477526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669766400000",
    "number": "1215489000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1907 BOYS REPUBLIC DR",
            "city": "CHINO HILLS",
            "state": "CA",
            "postal_code": "917095447",
            "telephone_number": "909-628-1217",
            "fax_number": "909-627-9222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "733 N GAREY AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "91767",
            "telephone_number": "909-622-3556",
            "fax_number": "909-306-5427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOYS REPUBLIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BOYS REPUBLIC",
        "enumeration_date": "2016-10-27",
        "last_updated": "2022-11-30",
        "certification_date": "2022-11-30",
        "status": "A",
        "authorized_official_last_name": "DARK",
        "authorized_official_first_name": "BAYLEY",
        "authorized_official_title_or_position": "CLINICIAN/HEAD OF SERVICE",
        "authorized_official_telephone_number": "909-536-6611",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boys Republic - Pomona Residence",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Pomona, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2022; 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.