Healthcare Provider Details

I. General information

NPI: 1174743363
Provider Name (Legal Business Name): YOLO COMMUNITY CARE CONTINUUM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 06/21/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

584 KENTUCKY AVENUE
WOODLAND CA
95695
US

IV. Provider business mailing address

PO BOX 1101
DAVIS CA
95617-1101
US

V. Phone/Fax

Practice location:
  • Phone: 530-661-3213
  • Fax: 530-661-3027
Mailing address:
  • Phone: 530-661-3213
  • Fax: 630-661-3027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number577003619
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHA910018
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number577003619
License Number StateCA

VIII. Authorized Official

Name: MS. AMBER SALAZAR
Title or Position: EXECUTIVE DIRECTOR
Credential: LMFT
Phone: 530-758-2160