Organization
EGGLESTON YOUTH CENTERS, INC.
Active
Parent organization
EGGLESTON YOUTH CENTERS, INC.
Other names
Eggleston Substance Abuse and Education Program
Organization subpart
Yes
Provider details
NPI number
Legal business name
EGGLESTON YOUTH CENTERS, INC.
Authorized official
CASSANDRA ELAINE GIBSON-JUDKINS LCSW (ASSISTANT EXECUTIVE DIRECTOR)
(626) 480-8107
Entity
Organization
Contact information
Practice address
13001 RAMONA BLVD STE J, IRWINDALE, CA 91706-3752
(626) 480-8107
Mailing address
13001 RAMONA BLVD STE J, IRWINDALE, CA 91706-3752
(626) 480-8107
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7427
MEDI-CAL
CA
Enumeration date
12/21/2011
Last updated
02/01/2018
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