NPIMap

Organization Active NPI

Eggleston Youth Centers, Inc.

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Ontario, CA
National Provider Identifier
1831636059
Registry record updated Apr 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
366426271 Issued in CA
Legal business name
EGGLESTON YOUTH CENTERS, INC.
Practice address
10806 Rose Ave
Ontario, CA 91762-4027
Phone
(626) 480-8107
Fax
(626) 869-0280
NPI assigned
Jan 25, 2017
Organization subpart
Yes
Parent organization
EGGLESTON YOUTH CENTERS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 25, 2018

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

Authorized official

Name
Cassandra Elaine Gibson-Judkins, LCSW
Title
Assistant Executive Director
Phone
(626) 480-8107

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X 366426271 CA Primary

Addresses

Primary practice location

10806 Rose Ave
Ontario, CA 91762-4027

Mailing address

13001 Ramona Blvd Ste E
Irwindale, CA 91706-3752
Phone (626) 480-8107

Other names 1

  • Eggleston BHS - Ontario Other name

National Provider Directory

National Provider Directory
Tax ID family
Eggleston Youth Centers Inc15 organizations share this tax ID, including this one
Part of
Eggleston Youth Centers Inc

Other organizations with this tax ID 14

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

View all 14

Practitioners & affiliated clinicians

Practitioners 1

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": "1485302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524614400000",
    "number": "1831636059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13001 RAMONA BLVD STE E",
            "city": "IRWINDALE",
            "state": "CA",
            "postal_code": "917063752",
            "telephone_number": "626-480-8107",
            "fax_number": "626-869-0280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10806 ROSE AVE",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917624027",
            "telephone_number": "626-480-8107",
            "fax_number": "626-869-0280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EGGLESTON YOUTH CENTERS, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EGGLESTON YOUTH CENTERS, INC.",
        "enumeration_date": "2017-01-25",
        "last_updated": "2018-04-25",
        "status": "A",
        "authorized_official_last_name": "GIBSON-JUDKINS",
        "authorized_official_first_name": "CASSANDRA",
        "authorized_official_middle_name": "ELAINE",
        "authorized_official_title_or_position": "ASSISTANT EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "626-480-8107",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "CA",
            "license": "366426271",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eggleston BHS - Ontario",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Eggleston BHS - Ontario",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Ontario, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2018; 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.