SAN GABRIEL CHILDRENS CENTER (NPI# 1205384559) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205384559 |
| Entity Type | Organization |
| Organization Name | SAN GABRIEL CHILDRENS CENTER |
| Other Organization Name | SGCC-HOMEREST HOME |
| Practice Address |
5329 N Homerest Ave Azusa CA 91702-5429 |
| Mailing Address |
2200 E Route 66 Glendora CA 91740-4659 |
| Practice Telephone | 6268592089 |
| Practice Fax Number | 6268596537 |
| Mailing Telephone | 6268592089 |
| Mailing Fax Number | 6268596537 |
| Enumeration Date | 2016-09-15 |
| Last Update Date | 2016-10-11 |
| Authorized Official Name | MR. PORFIRIO RINCON (CEO) |
| Authorized Official Telephone | 6268592089 |
| 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 |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 0000056BJ | 05 |
| Other Name | Type Code |
|---|---|
| SGCC-Homerest Home | Other Name - Individual/Organization |
| 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 |
| 1366994279 | San Gabriel Childrens Center | Residential Treatment Facility, Emotionally Disturbed Children | 5329 N Homerest Ave, Azusa, CA 91702-5429 | 2016-10-26 |
| 1316256670 | San Gabriel Childrens Center | Residential Treatment Facility, Emotionally Disturbed Children | 4740 N Grand Ave, Covina, CA 91724-2005 | 2010-10-04 |
| Street Address |
5329 N HOMEREST AVE |
| City | AZUSA |
| State | CA |
| Zip Code | 91702-5429 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366994279 | San Gabriel Childrens Center | Residential Treatment Facility, Emotionally Disturbed Children | 5329 N Homerest Ave, Azusa, CA 91702-5429 | 2016-10-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407345341 | Rosaura Contreras | Nutritionist | 109 West 6th Street, Azusa, CA 91702 | 2018-05-07 |
| 1093224396 | Beatriz Leyva Torres | Nurse Practitioner | 237 S. Vernon Ave, Azusa, CA 91702 | 2017-09-29 |
| 1871949370 | Angela Marie Mckindley | Case Manager/Care Coordinator | 23701 East Fork Rd., Azusa, CA 91702 | 2016-05-13 |
| 1023489846 | Crystal Horton | Case Manager/Care Coordinator | 23701 E Fork Road, Azusa, CA 91702 | 2015-10-20 |
| 1528438272 | Seann Mckay | Case Manager/Care Coordinator | 23701 E Folk Rd, Azusa, CA 91702 | 2015-10-06 |
| 1437528833 | William Clabaugh | Case Manager/Care Coordinator | 830 S. Azusa Ave., 45, Azusa, CA 91702 | 2015-09-16 |
| 1467850693 | Juana Gaeta | Speech-Language Pathologist | 1016 E Ghent St, Azusa, CA 91702 | 2014-12-22 |
| 1649674508 | Colleen Anne Montz | Nurse Practitioner | 901 E. Alosta Ave., Student Health Center, Azusa, CA 91702 | 2014-10-21 |
| 1285061390 | Patrick Ryan Bergeron | Physical Therapist | 900 W Sierra Madre Avenue, #33, Azusa, CA 91702 | 2013-10-03 |
| 1760768972 | Ashley L Wickliffe | Student in an Organized Health Care Education/Training Program | 901 East Alosta Avenue, Azusa, CA 91702 | 2011-11-01 |
| Find all providers in zip 91702 | ||||
| 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 |
|---|---|---|---|---|
| 1649722554 | San Gabriel Children's Center, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 337 South Enid Ave, Azusa, CA 91702-4302 | 2016-10-26 |
| 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 |
| 1366994279 | San Gabriel Childrens Center | Residential Treatment Facility, Emotionally Disturbed Children | 5329 N Homerest Ave, Azusa, CA 91702-5429 | 2016-10-26 |
| 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 |
| Find all providers with the same taxonomy | ||||
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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.