NPIMap

Organization Active NPI

Boys Republic

  • Mental Illness Community Based Residential Treatment Facility
  • Chino Hills, CA
National Provider Identifier
1356032817
Registry record updated Dec 29, 2023
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
3606 John Watkins Way
Chino Hills, CA 91709-5453
Phone
(909) 740-3136
Fax
(909) 306-5427
NPI assigned
May 16, 2023
Last updated
Dec 29, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
BOYS REPUBLICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 29, 2023

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

Authorized official

Name
Michael Roa, LMFTNPI 1861825382
Title
Clinical Supervisor/Head of Service
Phone
(909) 925-8134

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X NU Primary

Addresses

Primary practice location

3606 John Watkins Way
Chino Hills, CA 91709-5453

Mailing address

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

Other names 1

  • Boys Republic - Graves STRTP 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.

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1684195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703808000000",
    "number": "1356032817",
    "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": "909-306-5427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3606 JOHN WATKINS WAY",
            "city": "CHINO HILLS",
            "state": "CA",
            "postal_code": "917095453",
            "telephone_number": "909-740-3136",
            "fax_number": "909-306-5427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOYS REPUBLIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BOYS REPUBLIC",
        "enumeration_date": "2023-05-16",
        "last_updated": "2023-12-29",
        "certification_date": "2023-12-29",
        "status": "A",
        "authorized_official_last_name": "ROA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CLINICAL SUPERVISOR/HEAD OF SERVICE",
        "authorized_official_telephone_number": "909-925-8134",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boys Republic - Graves STRTP",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Boys Republic - Graves STRTP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Chino Hills, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2023; 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.