Healthcare Provider Details

I. General information

NPI: 1467823674
Provider Name (Legal Business Name): SAINT JOHN'S PROGRAM FOR REAL CHANGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2015
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 JACKSON RD
SACRAMENTO CA
95826-3904
US

IV. Provider business mailing address

2443 FAIR OAKS BLVD
SACRAMENTO CA
95825-7684
US

V. Phone/Fax

Practice location:
  • Phone: 916-453-1482
  • Fax:
Mailing address:
  • Phone: 916-453-1482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberPSY 24140
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: SCOTT RICHARDS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: ED. D.
Phone: 917-751-1257