Healthcare Provider Details

I. General information

NPI: 1780057521
Provider Name (Legal Business Name): DHHS IHS CAO DESERT SAGE YOUTH WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2015
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39990 FAURE RD
HEMET CA
92544-9408
US

IV. Provider business mailing address

650 CAPITOL MALL RM 7100
SACRAMENTO CA
95814-4706
US

V. Phone/Fax

Practice location:
  • Phone: 916-930-3981
  • Fax:
Mailing address:
  • Phone: 916-930-3981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: BEVERLY MILLER
Title or Position: CALIFORNIA AREA DIRECTOR
Credential:
Phone: 916-930-3981