MEDICARE: DIOGENES YOUTH SERVICES INC

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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	340062AN	CA

General Provider Information

NPI Number	:	1639179658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIOGENES YOUTH SERVICES INC

Provider Business Mailing Address
First Line	:	9719 LINCOLN VILLAGE DR
Second Line	:	STE 110
City	:	SACRAMENTO
State	:	CA
Zip	:	95827-3303
Country	:	US
Telephone Number	:	916-369-5447
Fax Number	:	916-369-5389

Provider Business Practice Location Address
First Line	:	9719 LINCOLN VILLAGE DR
Second Line	:	STE 203
City	:	SACRAMENTO
State	:	CA
Zip	:	95827-3303
Country	:	US
Telephone Number	:	916-369-5447
Fax Number	:	916-369-5389

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. JAMES H BUETO
Credential	:	MPA
Telephone Number	:	916-369-5447

Provider Enumeration Date	:	08/01/2005
Last Update Date	:	08/22/2020

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