MEDICARE: CA YA SERVICES LLC

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
1	323P00000X	Psychiatric Residential Treatment Facility

General Provider Information

NPI Number	:	1124761390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CA YA SERVICES LLC

Provider Business Mailing Address
First Line	:	L-3969
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43260-3969
Country	:	US
Telephone Number	:	714-202-5166
Fax Number	:	844-721-8190

Provider Business Practice Location Address
First Line	:	2565 ALHAMBRA CT
Second Line	:
City	:	SANTA ROSA VALLEY
State	:	CA
Zip	:	93012-9326
Country	:	US
Telephone Number	:	714-202-5166
Fax Number	:	844-721-8190

Authorized Official
Title or Position	:	CHIEF LEGAL & DEVELOPMENT OFFICER
Name	:	KEITH THOMPSON
Credential	:
Telephone Number	:	949-432-4622

Provider Enumeration Date	:	04/15/2022
Last Update Date	:	10/14/2025

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