Healthcare Provider Details

I. General information

NPI: 1881757805
Provider Name (Legal Business Name): CHALLENGER YOUTH MEMORIAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 W AVENUE I
LANCASTER CA
93536-8312
US

IV. Provider business mailing address

40601 ROYAL LYTHAM CT
PALMDALE CA
93551-5608
US

V. Phone/Fax

Practice location:
  • Phone: 661-940-4120
  • Fax:
Mailing address:
  • Phone: 661-947-6463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberMFT36808
License Number StateCA

VIII. Authorized Official

Name: MRS. JANICE AUSTIN-TAYLOR
Title or Position: MENTAL HEALTH CLINICIAN
Credential: MFT
Phone: 661-940-4120