Organization
BOYS REPUBLIC
Active
Parent organization
BOYS REPUBLIC
Other names
Boys Republic - ILP STRTP
Organization subpart
Yes
Provider details
NPI number
Legal business name
BOYS REPUBLIC
Authorized official
JUDITH EDMUNDSON LPCC (CLINICAL SUPERVISOR/HEAD OF SERVICE)
(909) 925-7693
Entity
Organization
Contact information
Practice address
3624 MARGARET FOWLER CT, CHINO HILLS, CA 91709-5456
(909) 740-3133
(909) 306-5427
Mailing address
1907 BOYS REPUBLIC DR, CHINO HILLS, CA 91709-5447
(909) 628-1217
(909) 306-5427
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
05/17/2023
Last updated
12/29/2023
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