Healthcare Provider Details

I. General information

NPI: 1073298055
Provider Name (Legal Business Name): YOLO CRISIS NURSEY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 BALSAM PLACE
DAVIS CA
95618-1601
US

IV. Provider business mailing address

1107 KENNEDY PLACE SUITE 5
DAVIS CA
95616-1273
US

V. Phone/Fax

Practice location:
  • Phone: 530-758-6680
  • Fax:
Mailing address:
  • Phone: 530-758-6680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. JENNIFER S THAYER
Title or Position: PRESIDENT, BOARD OF DIRECTORS YOLO
Credential:
Phone: 530-400-0415