Healthcare Provider Details

I. General information

NPI: 1225549686
Provider Name (Legal Business Name): PARADISE OAKS YOUTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4221 WAYMAR CT
CARMICHAEL CA
95608-1659
US

IV. Provider business mailing address

6060 SUNRISE VISTA DR STE 2100
CITRUS HEIGHTS CA
95610-7068
US

V. Phone/Fax

Practice location:
  • Phone: 916-967-6253
  • Fax: 916-967-9413
Mailing address:
  • Phone: 916-967-6253
  • Fax: 916-967-9413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number347005967
License Number StateCA

VIII. Authorized Official

Name: JENNIFER THOMPSON
Title or Position: QUALITY ASSURANCE DIRECTOR
Credential:
Phone: 916-967-6253