SAN GABRIEL CHILDRENS CENTER (NPI# 1316256670) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316256670 |
| Entity Type | Organization |
| Organization Name | SAN GABRIEL CHILDRENS CENTER |
| Practice Address |
4740 N Grand Ave Covina CA 91724-2005 |
| Mailing Address |
1735 W Alps Dr Upland CA 91784-2512 |
| Practice Telephone | 6268592089 |
| Mailing Telephone | 9092612894 |
| Enumeration Date | 2010-10-04 |
| Last Update Date | 2010-10-04 |
| Authorized Official Name | MISS JACLYN SUZANNE FERTAL (TBS) |
| Authorized Official Telephone | 9092612894 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | Residential Treatment Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730631649 | San Gabriel Childrens Center | Residential Treatment Facility, Emotionally Disturbed Children | 952 E Nearfield St, Azusa, CA 91702-4751 | 2016-10-26 |
| 1568910818 | San Gabriel Childrens Center | Residential Treatment Facility, Emotionally Disturbed Children | 337 S Enid Ave, Azusa, CA 91702-4302 | 2016-09-15 |
| 1205384559 | San Gabriel Childrens Center | Residential Treatment Facility, Emotionally Disturbed Children | 5329 N Homerest Ave, Azusa, CA 91702-5429 | 2016-09-15 |
| 1366994279 | San Gabriel Childrens Center | Residential Treatment Facility, Emotionally Disturbed Children | 5329 N Homerest Ave, Azusa, CA 91702-5429 | 2016-10-26 |
| Street Address |
4740 N GRAND AVE |
| City | COVINA |
| State | CA |
| Zip Code | 91724-2005 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205979960 | Roxana Maselli | Rehabilitation Practitioner | 4740 N Grand Ave, Covina, CA 91724-2005 | 2007-02-14 |
| 1093312266 | Elsa Elizalde | Rehabilitation Practitioner | 4740 N Grand Ave, Covina, CA 91724-2005 | 2020-10-01 |
| 1790382950 | Brandon Funes | Rehabilitation Practitioner | 4740 N Grand Ave, Covina, CA 91724-2005 | 2020-10-01 |
| 1013567999 | Sandra Hernandez-chavez | Counselor | 4740 N Grand Ave, Covina, CA 91724-2005 | 2019-09-12 |
| 1144879370 | Ismael L. Ramirez | Licensed Psychiatric Technician | 4740 N Grand Ave, Covina, CA 91724-2005 | 2019-09-10 |
| 1750849295 | Sylvia Arias | Licensed Psychiatric Technician | 4740 N Grand Ave, Covina, CA 91724-2005 | 2019-03-04 |
| 1912475997 | Erika R Ozuna | Rehabilitation Practitioner | 4740 N Grand Ave, Covina, CA 91724-2005 | 2018-11-07 |
| 1528536760 | Diandra Elise La Croix | Counselor | 4740 N Grand Ave, Covina, CA 91724-2005 | 2018-11-06 |
| 1780164061 | Gabrielle N Kubulan | Counselor | 4740 N Grand Ave, Covina, CA 91724-2005 | 2018-08-16 |
| 1215415096 | Jennifer K Flores | Rehabilitation Practitioner | 4740 N Grand Ave, Covina, CA 91724 | 2018-08-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902320922 | Kimberly Suzanne Manzanares-mora | Rehabilitation Practitioner | 1359 North Grand Avenue, Covina, CA 91724 | 2017-08-01 |
| 1689194680 | Cynthia Garcia | Counselor | 1359 N. Grand Ave., Covina, CA 91724 | 2017-06-21 |
| 1386191963 | West Covina Group Corporation | Residential Treatment Facility, Emotionally Disturbed Children | 1274 Center Court Dr, #208, Covina, CA 91724 | 2016-09-01 |
| 1184094781 | Veronica May Roberts | Licensed Vocational Nurse | 222 S. Wilson Ave, Covina, CA 91724 | 2015-09-25 |
| 1912216292 | Joan Mendoza | Social Worker | 1338 Center Court Dr Ste 107, Covina, CA 91724 | 2010-10-04 |
| 1548583602 | Lille-anne Nzeribe | Rehabilitation Practitioner | 1126 N. Grand Ave. Suite D, Covina, CA 91724 | 2010-03-03 |
| 1154534212 | Verna L Lewis | Marriage & Family Therapist | 420 South Grand Ave., Covina, CA 91724 | 2007-05-07 |
| 1093937310 | Heather Annn Pedevillano | Specialist/Technologist | 1805 E. Lomira Dr, Covina, CA 91724 | 2007-05-03 |
| 1669503579 | Maritza Mercedes Reyes | Rehabilitation Practitioner | 1411 N. Grand Ave., Covina, CA 91724 | 2007-03-09 |
| 1417014085 | Bernadette Luyun Guaring Bagay | Dentist | 984 E Badillo St, Suite E, Covina, CA 91724 | 2007-01-03 |
| Find all providers in zip 91724 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740747096 | Careprovider Org Foundation | Residential Treatment Facility, Emotionally Disturbed Children | 281 E Workman St Ste 203, Covina, CA 91723-3566 | 2019-02-22 |
| 1568913580 | Careprovider Org Foundation | Residential Treatment Facility, Emotionally Disturbed Children | 858 Kidder Ave, Covina, CA 91724-2615 | 2016-10-14 |
| 1386191963 | West Covina Group Corporation | Residential Treatment Facility, Emotionally Disturbed Children | 1274 Center Court Dr, #208, Covina, CA 91724 | 2016-09-01 |
| 1992822621 | San Gabriel Children's Center Incorporated | Residential Treatment Facility, Emotionally Disturbed Children | 4740 N Grand Ave, Covina, CA 91724-2005 | 2007-03-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144820499 | Catholic Charities of The Diocese of Oakland | Residential Treatment Facility, Emotionally Disturbed Children | 3700 Dorisa Ave, Oakland, CA 94605-4941 | 2020-10-27 |
| 1922607944 | Inspire A Youth, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 7556 Avenida Baja, Riverside, CA 92509-3449 | 2020-10-21 |
| 1235736554 | Yvonne Dionne Robinson | Residential Treatment Facility, Emotionally Disturbed Children | 1223 E Helmick St, Carson, CA 90746-3163 | 2020-10-09 |
| 1740897784 | Paradise Adolescent Home, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 602 Woodlark Dr, Suisun City, CA 94585-2244 | 2020-09-24 |
| 1548877657 | T & T House of Champions | Residential Treatment Facility, Emotionally Disturbed Children | 2115 High St, Oakland, CA 94601-4335 | 2020-09-23 |
| 1902412182 | Paradise Adolescent Home, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 136 Valdivia Cir, San Ramon, CA 94583-2228 | 2020-09-22 |
| 1073128492 | Samuel Campbell Jr. | Residential Treatment Facility, Emotionally Disturbed Children | 4200 Crescent Rock Ln, Bakersfield, CA 93311-2860 | 2020-09-11 |
| 1336753433 | Aaron's Boys Home | Residential Treatment Facility, Emotionally Disturbed Children | 5805 Capistrano Ave Ste E, Atascadero, CA 93422-7218 | 2020-09-04 |
| 1699389452 | Millie's Youth Services, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 2512 Havenscourt Blvd, Oakland, CA 94605-1935 | 2020-08-31 |
| 1538779871 | Hidden Treasures Foundation, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 1240 W 13th Ave, Escondido, CA 92025-5560 | 2020-08-02 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.