| NPI | 1700336559 |
|---|---|
| Other Name | BOYS REPUBLIC - GIRLS REPUBLIC |
| Entity Type | Organization |
| Authorized Contact | ELLEN STRICKLAND Residence Clinical Supervisor 909-287-6433 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2016-10-05 |
| Last Update Date | 2022-11-30 |