Provider Demographics
NPI:1730463548
Name:EGGLESTON YOUTH CENTERS, INC.
Entity Type:Organization
Organization Name:EGGLESTON YOUTH CENTERS, INC.
Other - Org Name:EGGLESTON FAMILY SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSISTANT EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:GIBSON-JUDKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:626-480-8107
Mailing Address - Street 1:3001 W VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-5293
Mailing Address - Country:US
Mailing Address - Phone:323-954-1464
Mailing Address - Fax:323-954-9515
Practice Address - Street 1:3001 W VERNON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-5293
Practice Address - Country:US
Practice Address - Phone:323-954-1464
Practice Address - Fax:323-954-9515
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EGGLESTON YOUTH CENTERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-29
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197805862253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency