Healthcare Provider Details

I. General information

NPI: 1811688302
Provider Name (Legal Business Name): THE YOUNG MEN'S CHRISTIAN ASSOCIATION OF SUPERIOR CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 W ST
SACRAMENTO CA
95818-1625
US

IV. Provider business mailing address

1926 V ST
SACRAMENTO CA
95818-1624
US

V. Phone/Fax

Practice location:
  • Phone: 916-452-9622
  • Fax:
Mailing address:
  • Phone: 916-529-9886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: TATIANA STARR DANIELS
Title or Position: CLINICAL DIRECTOR
Credential: LCSW
Phone: 916-231-7297