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General NPI Number Information
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NPI Number | 1861848525
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Entity Type | Organization
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Legal Business Name | TRINITY YOUTH SERVICES
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Dates
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Enumeration Date | 05/11/2016
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Last Update Date | 10/15/2017
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Provider Practice Location Address
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Address Line | 10776 FREMONT ST
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City | YUCAIPA
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State | CA
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Zip | 92399-9630
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Country | US
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Telephone | 909-797-0114
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Fax | 909-790-2148
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Provider Business Mailing Address
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Address Line | 10776 FREMONT ST
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City | YUCAIPA
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State | CA
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Zip | 92399-9630
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Country | US
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Telephone | 909-797-0114
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Fax | 909-790-2148
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. JAMES R. ADAMS IV
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Credential |
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Telephone | 626-444-0539
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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 | CA
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Taxonomy #2
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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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