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General NPI Number Information
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NPI Number | 1699389452
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Entity Type | Organization
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Legal Business Name | MILLIE'S YOUTH SERVICES, INC.
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Dates
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Enumeration Date | 08/31/2020
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Last Update Date | 05/13/2021
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Provider Practice Location Address
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Address Line | 2512 HAVENSCOURT BLVD
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City | OAKLAND
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State | CA
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Zip | 94605-1935
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Country | US
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Telephone | 510-568-4601
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Fax | 510-568-4339
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Provider Business Mailing Address
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Address Line | 21 CAMISA CIR
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City | OAKLAND
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State | CA
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Zip | 94605-4919
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Country | US
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Telephone | 510-772-8458
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MILLIE WINN
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Credential |
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Telephone | 510-772-8458
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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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