Healthcare Provider Details

I. General information

NPI: 1790805216
Provider Name (Legal Business Name): TAHOE YOUTH AND FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 FREMONT AVENUE
SOUTH LAKE TAHOE CA
96150-8136
US

IV. Provider business mailing address

1021 FREMONT AVE
SOUTH LAKE TAHOE CA
96150-8136
US

V. Phone/Fax

Practice location:
  • Phone: 530-541-2445
  • Fax: 530-541-0517
Mailing address:
  • Phone: 530-541-2445
  • Fax: 530-541-0517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. CHEYANNE LANE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 530-541-2445