| NPI | 1083305411 |
|---|---|
| Other Name | BOYS REPUBLIC - ILP STRTP |
| Entity Type | Organization |
| Authorized Contact | JUDITH EDMUNDSON Clinical Supervisor/Head Of Service 909-925-7693 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2023-05-17 |
| Last Update Date | 2023-12-29 |