Organization
BOYS REPUBLIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FEDERICO ESCOBEDO JARQUE LMFT, LPCC (CLINICAL DIRECTOR)
(909) 628-1217
Entity
Organization
Contact information
Practice address
1907 BOYS REPUBLIC DR, CHINO HILLS, CA 91709-5447
(909) 628-1217
(909) 306-5427
Mailing address
1907 BOYS REPUBLIC DR, CHINO HILLS, CA 91709-5447
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
03/01/2019
Last updated
11/30/2022
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