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General NPI Number Information
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NPI Number | 1669829685
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Entity Type | Organization
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Legal Business Name | CALO YOUNG ADULT
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Dates
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Enumeration Date | 05/19/2016
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 5500 MING AVE STE 410
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City | BAKERSFIELD
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State | CA
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Zip | 93309-4631
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Country | US
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Telephone | 661-622-4132
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Fax | 573-365-2224
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Provider Business Mailing Address
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Address Line | PO BOX 1810
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City | LAKE OZARK
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State | MO
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Zip | 65049-1810
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Country | US
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Telephone | 661-622-4132
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Fax | 573-365-2224
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | SHARNELL SPENCER
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Credential |
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Telephone | 661-239-6923
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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