Organization
BOYS REPUBLIC
Active
Parent organization
BOYS REPUBLIC
Organization subpart
Yes
Provider details
NPI number
Legal business name
BOYS REPUBLIC
Authorized official
FEDERICO ESCOBEDO JARQUE LMFT, LPCC (CLINICAL DIRECTOR)
(909) 628-1217
Entity
Organization
Contact information
Practice address
3850 EUCALYPTUS AVE, CHINO HILLS, CA 91709-1807
(909) 597-9974
(909) 627-9222
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
10/05/2016
Last updated
11/30/2022
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