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General NPI Number Information
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NPI Number | 1548859556
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Entity Type | Organization
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Legal Business Name | WILLIE YOUNG'S HOME FOR YOUNG MEN
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Dates
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Enumeration Date | 01/14/2021
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Last Update Date | 01/14/2021
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Provider Practice Location Address
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Address Line | 4200 CRESCENT ROCK LN
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City | BAKERSFIELD
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State | CA
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Zip | 93311-2860
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Country | US
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Telephone | 661-491-3402
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Fax | 661-491-3400
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Provider Business Mailing Address
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Address Line | 9556 LANGDON AVE
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City | NORTH HILLS
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State | CA
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Zip | 91343-2103
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Country | US
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Telephone | 310-930-0199
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Fax | 818-475-1914
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Authorized Official
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Title or Position | PRESIDENT /DIRECTOR
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Name | MR. SAMUEL CAMPBELL JR.
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Credential |
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Telephone | 310-930-0199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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