Organization
BOYS & GIRLS CLUBS OF GARDEN GROVE, INC.
Active
Organization
BOYS & GIRLS CLUBS OF GARDEN GROVE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK SURMANIAN (CHIEF EXECUTIVE OFFICER)
(714) 530-0430
Entity
Organization
Contact information
Practice address
11301 ACACIA PKWY, GARDEN GROVE, CA 92840-5310
(714) 741-5895
(714) 636-0351
Mailing address
10540 CHAPMAN AVE, GARDEN GROVE, CA 92840-3101
(714) 530-0430
(714) 530-0431
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
07/19/2016
Last updated
07/19/2016
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