Healthcare Provider Details

I. General information

NPI: 1386206274
Provider Name (Legal Business Name): YOUTH HOMES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 07/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1159 EVERETT CT
CONCORD CA
94518-1714
US

IV. Provider business mailing address

3480 BUSKIRK AVE STE 210
PLEASANT HILL CA
94523-4304
US

V. Phone/Fax

Practice location:
  • Phone: 925-933-2627
  • Fax: 925-933-5824
Mailing address:
  • Phone: 925-933-2627
  • Fax: 925-933-5824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SHAINA VAN PELT
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 928-876-1153