NPIMap

Organization Active NPI

Boys & Girls Clubs of Garden Grove, Inc.

  • Early Intervention Provider Agency
  • Garden Grove, CA
National Provider Identifier
1871946442
Registry record updated Jul 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Early Intervention Provider AgencyTaxonomy code 252Y00000X
Legal business name
BOYS & GIRLS CLUBS OF GARDEN GROVE, INC.
Practice address
11301 Acacia Pkwy
Garden Grove, CA 92840-5310
Phone
(714) 741-5895
Fax
(714) 636-0351
NPI assigned
Jul 19, 2016
Last updated
Jul 19, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2016

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

Authorized official

Name
Mr. Mark Surmanian
Title
Chief Executive Officer
Phone
(714) 530-0430

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Early Intervention Provider Agency 252Y00000X NU Primary

Addresses

Primary practice location

11301 Acacia Pkwy
Garden Grove, CA 92840-5310

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.

Practitioners & affiliated clinicians

Practitioners 4

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": "1468886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468886400000",
    "number": "1871946442",
    "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": "11301 ACACIA PKWY",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928405310",
            "telephone_number": "714-741-5895",
            "fax_number": "714-636-0351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOYS & GIRLS CLUBS OF GARDEN GROVE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-19",
        "last_updated": "2016-07-19",
        "status": "A",
        "authorized_official_last_name": "SURMANIAN",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "714-530-0430",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "NU",
            "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 Jul 19, 2016; 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.