Organization
EGGLESTON YOUTH CENTERS, INC.
Active
Other names
Eggleston Substance Abuse and Education Program, Eggleston Substance Abuse and Education Program
Organization subpart
No
Provider details
NPI number
Authorized official
CASSANDRA ELAINE GIBSON-JUDKINS LCSW (ASSISTANT EXECUTIVE DIRECTOR)
(626) 480-8107
Entity
Organization
Contact information
Practice address
13001 RAMONA BLVD STE E, IRWINDALE, CA 91706-3752
(626) 480-8107
Mailing address
13001 RAMONA BLVD., SUITE E, IRWINDALE, CA 91706
(626) 627-6000
(626) 480-7688
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
190716AN
DEPT OF ALCOHOL AND DRUG PROGRAMS
CA
01
—
197427
MASTER PROVIDER FILE NO.
CA
01
—
7427
DRUG MEDI-CAL BILLING NO.
CA
Enumeration date
01/09/2013
Last updated
06/16/2018
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