EGGLESTON YOUTH CENTERS INC. NPI 1467920769

NPI Information

  • NPI: 1467920769
  • Provider Name: EGGLESTON YOUTH CENTERS, INC.
  • Classification: Residential Treatment Facility, Emotionally Disturbed Children - 322D00000X
  • Entity Type: Organization
  • Other Name: EGGLESTON BHS - LA VERNE 2
  • Address: 790 E LA VERNE AVE
    POMONA, CA
    ZIP 91767
  • Phone: (626) 480-8107

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NPI Details

EGGLESTON YOUTH CENTERS, INC. is a residential treatment facility emotionally disturbed children in Pomona, CA. The provider is a residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral issues, and intellectual disabilities and are not able to live independently. EGGLESTON YOUTH CENTERS, INC. NPI is 1467920769. The provider is registered as an organization entity type.
The provider Other Name Is Eggleston Bhs - La Verne 2.

The provider's business location address is:

790 E LA VERNE AVE
POMONA, CA
ZIP 91767-814
Phone: (626) 480-8107
Fax: (626) 869-0280

The provider's authorized official is Cassandra Elaine Gibson-judkins .
The authorized official title is Assistant Executive Director and has the following contact phone number (626) 480-8107.

The enumeration date for this NPI number is 11/5/2018 and was last updated on 11/5/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QM0855XClinic/CenterAdolescent and Children Mental HealthNo
2322D00000XResidential Treatment Facility, Emotionally Disturbed ChildrenYes

What is NPI?

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This page was last updated on: 3/30/2025

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