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General NPI Number Information
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NPI Number | 1841453438
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Entity Type | Organization
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Legal Business Name | YOUTH FOR CHANGE
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Dates
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Enumeration Date | 07/03/2008
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Last Update Date | 05/14/2018
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Provider Practice Location Address
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Address Line | 572 RIO LINDO AVE STE 104B&D
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City | CHICO
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State | CA
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Zip | 95926
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Country | US
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Telephone | 530-877-4786
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Fax | 530-894-5791
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Provider Business Mailing Address
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Address Line | PO BOX 1476
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City | PARADISE
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State | CA
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Zip | 95967-1476
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Country | US
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Telephone | 530-877-8187
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Fax | 530-894-5791
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | ROSEMARY LISA KELLY
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Credential |
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Telephone | 530-894-5933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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