Healthcare Provider Details

I. General information

NPI: 1003953027
Provider Name (Legal Business Name): YOUTH FOR CHANGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 08/21/2012
Certification Date:
Deactivation Date: 09/13/2007
Reactivation Date: 08/25/2010

III. Provider practice location address

7200 SKYWAY
PARADISE CA
95969-3280
US

IV. Provider business mailing address

PO BOX 1476
PARADISE CA
95967
US

V. Phone/Fax

Practice location:
  • Phone: 530-877-8187
  • Fax: 530-894-5791
Mailing address:
  • Phone: 530-877-8187
  • 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 StateCA

VIII. Authorized Official

Name: MR. GEORGE MADISON SILER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 530-877-8187