| Boys Republic - Pomona Residence | |
|
733 N Garey Ave Pomona CA 91767 | |
| (909) 622-3556 | |
| (909) 306-5427 |
| Full Name | Boys Republic - Pomona Residence |
|---|---|
| Speciality | Community Based Residential Treatment Facility, Mental Illness |
| Location | 733 N Garey Ave, Pomona, California |
| Authorized Official Name and Position | Bayley Dark (CLINICIAN/HEAD OF SERVICE) |
| Authorized Official Contact | 9095366611 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Boys Republic - Pomona Residence 1907 Boys Republic Dr Chino Hills CA 91709-5447 Ph: (909) 628-1217 | Boys Republic - Pomona Residence 733 N Garey Ave Pomona CA 91767 Ph: (909) 622-3556 |
| NPI Number | 1215489000 |
|---|---|
| Provider Enumeration Date | 10/27/2016 |
| Last Update Date | 11/30/2022 |
| Certification Date | 11/30/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215489000 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 320800000X | Community Based Residential Treatment Facility, Mental Illness | (* (Not Available)) | Primary |
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