NPIMap

Organization Active NPI

Eggleston Youth Centers, Inc.

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • West Covina, CA
National Provider Identifier
1972040194
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
197806374 Issued in CA
Legal business name
EGGLESTON YOUTH CENTERS, INC.
Practice address
1526 S St Malo St
West Covina, CA 91790-4836
Phone
(626) 480-8107
Fax
(626) 869-0280
NPI assigned
Jan 25, 2017
Last updated
Apr 25, 2018By the provider in NPPES
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, LCSWNPI 1780725887
Title
Assistant Executive Director
Phone
(626) 480-8107

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X 197806374 CA Primary

Addresses

Primary practice location

1526 S St Malo St
West Covina, CA 91790-4836

Mailing address

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

Other names 1

  • Eggleston BHS - West Covina Other name

National Provider Directory

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

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, 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": "1485302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524614400000",
    "number": "1972040194",
    "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": "1526 S ST MALO ST",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917904836",
            "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": "197806374",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eggleston BHS - West Covina",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Eggleston BHS - West Covina",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in West 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, 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.