Basic Information
| Provider Information | |||||||||
| NPI: | 1083010409 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHAMBERLAIN'S YOUTH SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1850 SAN BENITO ST | ||||||||
| Address2: | |||||||||
| City: | HOLLISTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950234899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316362121 | ||||||||
| FaxNumber: | 8316365296 | ||||||||
| Practice Location | |||||||||
| Address1: | 1850 SAN BENITO ST | ||||||||
| Address2: | |||||||||
| City: | HOLLISTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950234899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316362121 | ||||||||
| FaxNumber: | 8316365296 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2014 | ||||||||
| LastUpdateDate: | 03/21/2019 | ||||||||
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| AuthorizedOfficialLastName: | DAVIS | ||||||||
| AuthorizedOfficialFirstName: | MELANIE | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | DIR. MENTAL HEALTH SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 8316362121 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 322D00000X | N | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children | 322D00000X | 355201170 | CA | Y | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children |
No ID Information.