Basic Information
| Provider Information | |||||||||
| NPI: | 1124538681 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | YOUTH FOR CHANGE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 578 RIO LINDO AVE STE 3 | ||||||||
| Address2: | |||||||||
| City: | CHICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959261800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308945933 | ||||||||
| FaxNumber: | 5308945791 | ||||||||
| Practice Location | |||||||||
| Address1: | 1525 PLUMAS COURT | ||||||||
| Address2: | SUITES C & D | ||||||||
| City: | YUBA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95991 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308945933 | ||||||||
| FaxNumber: | 5308945791 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2017 | ||||||||
| LastUpdateDate: | 10/10/2017 | ||||||||
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| AuthorizedOfficialLastName: | KELLY | ||||||||
| AuthorizedOfficialFirstName: | ROSEMARY | ||||||||
| AuthorizedOfficialMiddleName: | LISA | ||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 5308945933 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0855X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
No ID Information.