Provider Demographics
NPI:1992822621
Name:SAN GABRIEL CHILDREN'S CENTER INCORPORATED
Entity Type:Organization
Organization Name:SAN GABRIEL CHILDREN'S CENTER INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAJERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-859-2089
Mailing Address - Street 1:13435 MULBERRY DR APT 16
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-4651
Mailing Address - Country:US
Mailing Address - Phone:562-698-1692
Mailing Address - Fax:
Practice Address - Street 1:4740 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-2005
Practice Address - Country:US
Practice Address - Phone:626-859-2089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children