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General NPI Number Information
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NPI Number | 1679431795
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Entity Type | Organization
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Legal Business Name | POTTER VALLEY YOUTH AND COMMUNITY CENTER, INC.
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Dates
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Enumeration Date | 01/15/2026
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Last Update Date | 01/15/2026
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Provider Practice Location Address
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Address Line | 10270 MAIN STREET STREET
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City | POTTER VALLEY
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State | CA
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Zip | 95469
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Country | US
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Telephone | 707-743-1789
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 273
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City | POTTER VALLEY
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State | CA
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Zip | 95469-0273
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BUSINESS ADMINISTRATOR
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Name | ALICIA LOGAN
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Credential |
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Telephone | 707-272-1097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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