Healthcare Provider Details

I. General information

NPI: 1033660642
Provider Name (Legal Business Name): YOUTH FOR CHANGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

572 RIO LINDO AVE SUITE 206
CHICO CA
95926-1851
US

IV. Provider business mailing address

578 RIO LINDO AVE SUITE 3
CHICO CA
95926-1800
US

V. Phone/Fax

Practice location:
  • Phone: 530-894-5933
  • Fax: 530-894-5791
Mailing address:
  • Phone: 530-894-5933
  • Fax: 530-894-5791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GEORGE MADISON SILER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 530-877-8187