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NPI Code Detail

MEDICARE: EGGLESTON YOUTH CENTERS, INC.

MEDICARE: EGGLESTON YOUTH CENTERS, INC.
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
1261QM0855XAdolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number : 1285916882
Entity Type Code : Organization
Provider Name (Legal Business Name) : EGGLESTON YOUTH CENTERS, INC.
Provider Business Mailing Address
First Line : 3001 W VERNON AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90008-5293
Country : US
Telephone Number : 323-299-9554
Fax Number : 323-299-9540
Provider Business Practice Location Address
First Line : 3001 W VERNON AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90008-5293
Country : US
Telephone Number : 323-299-9554
Fax Number : 323-299-9540
Authorized Official
Title or Position : ASSISTANT EXECUTIVE DIRECTOR
Name : CASSANDRA ELAINE GIBSON-JUDKINS
Credential : LCSW
Telephone Number : 626-480-8107
Provider Enumeration Date : 09/09/2011
Last Update Date : 03/17/2020

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Directions to “EGGLESTON YOUTH CENTERS, INC. ” Practice Location

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