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NPI Code Detail

MEDICARE: BOYS REPUBLIC

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
1320800000XMental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number : 1700577137
Entity Type Code : Organization
Provider Name (Legal Business Name) : BOYS REPUBLIC
Provider Business Mailing Address
First Line : 1907 BOYS REPUBLIC DRIVE
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 : 3608 STEVE MCQUEEN DRIVE
Second Line :
City : CHINO HILLS
State : CA
Zip : 91709-5455
Country : US
Telephone Number : 909-740-3138
Fax Number : 909-306-5427
Authorized Official
Title or Position : CLINICAL SUPERVISOR/HEAD OF SERVICE
Name : AMANDA CUNNINGS
Credential : LCSW
Telephone Number : 909-703-0462
Provider Enumeration Date : 05/17/2023
Last Update Date : 03/26/2025

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Directions to “BOYS REPUBLIC ” Practice Location

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