Healthcare Provider Details

I. General information

NPI: 1356090203
Provider Name (Legal Business Name): SACRAMENTO YOUTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2022
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 DEL PASO BLVD
SACRAMENTO CA
95815-3020
US

IV. Provider business mailing address

1901 DEL PASO BLVD
SACRAMENTO CA
95815-3020
US

V. Phone/Fax

Practice location:
  • Phone: 916-248-1081
  • Fax:
Mailing address:
  • Phone: 916-248-1081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name: RAQUEL SHIPP
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 916-248-1081