NPIMap

Organization Active NPI

Boys & Girls Clubs of Garden Grove

  • Adolescent and Children Mental Health Clinic/Center
  • Garden Grove, CA
National Provider Identifier
1245431808
Registry record updated Dec 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
BOYS & GIRLS CLUBS OF GARDEN GROVE
Practice address
13645 Clinton St
Garden Grove, CA 92843
Phone
(714) 530-0430
Fax
(714) 530-0431
NPI assigned
May 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2024

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

Authorized official

Name
Mark Surmanian
Title
Ceo
Phone
(714) 530-0430

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X
Adolescent and Children Mental Health Clinic/Center 261QM0855X Primary

Addresses

Primary practice location

13645 Clinton St
Garden Grove, CA 92843

Mailing address

10540 Chapman Ave
Garden Grove, CA 92840-3101
Phone (714) 530-0430

National Provider Directory

National Provider Directory
Tax ID family
Boys Girls Clubs of Garden Grove4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

13645 Clinton St
Garden Grove, CA 92843
Phone (714) 530-0430

10602 Chapman Ave
Ste 101
Garden Grove, CA 92840
Phone (714) 532-7940

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733443200000",
    "number": "1245431808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10540 CHAPMAN AVE",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928403101",
            "telephone_number": "714-530-0430",
            "fax_number": "714-530-0431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13645 CLINTON ST",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "92843",
            "telephone_number": "714-530-0430",
            "fax_number": "714-530-0431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOYS & GIRLS CLUBS OF GARDEN GROVE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-30",
        "last_updated": "2024-12-06",
        "status": "A",
        "authorized_official_last_name": "SURMANIAN",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "714-530-0430"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Garden Grove, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 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.