| Organization Name: | EGGLESTON SUBSTANCE ABUSE AND EDUCATIONAL PROGRAM |
| NPI Number: | 1649517764 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CLARENCE BROWN (EXECUTIVE DIRECTOR) |
| Mailing Address: | 13001 Ramona Blvd Ste E Irwindale |
| State: | CA US |
| Postal Code: | 917063752 |
| Phone Number: | 6266276000 |
| Fax Number: | 6264807688 |
| NPI Enumeration Date: | 01/09/2013 |
| NPI Last Update Date: | 01/09/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 191500940 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |