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Organization
SAN GABRIEL CHILDREN'S CENTER INC.
Active
Organization
SAN GABRIEL CHILDREN'S CENTER INC.
Active
Other names
San Gabriel Children's Center Outpatient
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PORFIRIO RINCON (PRESIDENT/CEO)
(626) 859-2089
Entity
Organization
Contact information
Practice address
4740 N GRAND AVE, COVINA, CA 91724-2005
(626) 859-2089
(626) 859-6537
Mailing address
1211 CENTER COURT DR STE 105, COVINA, CA 91724-3613
(626) 859-2089
(626) 859-6537
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
7563A
CA
251S00000X
Community/Behavioral Health Agency
7563D
CA
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
197804961
CA
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
197804972
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000056BJ
—
CA
Enumeration date
03/14/2007
Last updated
05/01/2024
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