Organization
BOYS REPUBLIC
Active
Parent organization
BOYS REPUBLIC
Other names
Boys Republic - Pomona Residence
Organization subpart
Yes
Provider details
NPI number
Legal business name
BOYS REPUBLIC
Authorized official
BAYLEY DARK LCSW (CLINICIAN/HEAD OF SERVICE)
(909) 536-6611
Entity
Organization
Contact information
Practice address
733 N GAREY AVE, POMONA, CA 91767
(909) 622-3556
(909) 306-5427
Mailing address
1907 BOYS REPUBLIC DR, CHINO HILLS, CA 91709-5447
(909) 628-1217
(909) 627-9222
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
10/27/2016
Last updated
11/30/2022
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