NPIMap

Organization Active NPI

San Gabriel Children'S Center, Inc.

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Covina, CA
National Provider Identifier
1801346812
Registry record updated Apr 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
Legal business name
SAN GABRIEL CHILDREN'S CENTER, INC.
Practice address
4740 N Grand Ave
Covina, CA 91724-2005
Phone
(626) 859-2089
Fax
(626) 859-6537
NPI assigned
Oct 13, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2022

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

4740 N Grand Ave
Covina, CA 91724-2005

Mailing address

2200 E Route 66
Glendora, CA 91740-4659
Phone (626) 859-2089

Other identifiers 1

IdentifierTypeStateIssuer
0000056BJMedicaidCA

Other names 1

  • SGCC-Nearfield 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

2200 E Route 66
Glendora, CA 91740
Phone (626) 285-9208

NPI Registry JSON

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

{
    "created_epoch": "1476316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650844800000",
    "number": "1801346812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 E ROUTE 66",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917404659",
            "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": "4740 N GRAND AVE",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917242005",
            "telephone_number": "626-859-2089",
            "fax_number": "626-859-6537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN GABRIEL CHILDREN'S CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-13",
        "last_updated": "2022-04-25",
        "certification_date": "2022-04-25",
        "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-Nearfield Home",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "SGCC-Nearfield Home",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Covina, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 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.