MEDICARE: BOYS REPUBLIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1083305411
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOYS REPUBLIC

Provider Business Mailing Address
First Line	:	1907 BOYS REPUBLIC DR
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-5447
Country	:	US
Telephone Number	:	909-628-1217
Fax Number	:	909-306-5427

Provider Business Practice Location Address
First Line	:	3624 MARGARET FOWLER CT
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-5456
Country	:	US
Telephone Number	:	909-740-3133
Fax Number	:	909-306-5427

Authorized Official
Title or Position	:	CLINICAL SUPERVISOR/HEAD OF SERVICE
Name	:	JUDITH EDMUNDSON
Credential	:	LPCC
Telephone Number	:	909-925-7693

Provider Enumeration Date	:	05/17/2023
Last Update Date	:	12/29/2023

Similar Medicare Providers

1134625908 — JUDITH EDMUNDSON
Practice Location Address:

3624 MARGARET FOWLER CT
CHINO HILLS, CA
91709-5456

Practice Phone: 909-740-3133
Practice Fax: 909-306-5427

1215638143 — MARIAH JOLLENE ROSAUER
Practice Location Address:

3624 MARGARET FOWLER CT
CHINO HILLS, CA
91709-5456

Practice Phone: 909-740-3133
Practice Fax: 909-306-5427

1528435849 — MS. HIROMI WADA
Practice Location Address:

7236 112TH ST APT 314
FOREST HILLS, NY
11375-5456

Practice Phone: 914-826-5673
Practice Fax:

1922835982 — HOSSEAN ALZIYADI PA-C
Practice Location Address:

30305 TIMBERIDGE CIR APT 103
FARMINGTON HILLS, MI
48336-5456

Practice Phone: 313-888-7434
Practice Fax:

1114750981 — SAFE PASS MEDICAL TRANSPORTATION
Practice Location Address:

3833 SCHAEFER AVE STE C
CHINO, CA
91710-5456

Practice Phone: 951-772-8824
Practice Fax: 909-766-2995

1497072342 — MRS. MARY CHRISTINE RIVAS
Practice Location Address:

3833 SCHAEFER AVE , SUITE K
CHINO, CA
91710-5456

Practice Phone: 909-590-2260
Practice Fax:

Directions to “BOYS REPUBLIC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.