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NPI Code Detail

MEDICARE: PARADISE OAKS YOUTH SERVICES

MEDICARE: PARADISE OAKS YOUTH SERVICES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1320800000XMental Illness Community Based Residential Treatment Facility347005963CA

General Provider Information

NPI Number : 1083125215
Entity Type Code : Organization
Provider Name (Legal Business Name) : PARADISE OAKS YOUTH SERVICES
Provider Business Mailing Address
First Line : 6060 SUNRISE VISTA DR STE 2100
Second Line :
City : CITRUS HEIGHTS
State : CA
Zip : 95610-7068
Country : US
Telephone Number : 916-967-6253
Fax Number : 916-967-9413
Provider Business Practice Location Address
First Line : 6832 ROSA VISTA LN
Second Line :
City : CITRUS HEIGHTS
State : CA
Zip : 95610-3920
Country : US
Telephone Number : 916-967-6253
Fax Number : 916-967-9413
Authorized Official
Title or Position : QUALITY ASSURANCE DIRECTOR
Name : JENNIFER THOMPSON
Credential :
Telephone Number : 916-967-6253
Provider Enumeration Date : 10/16/2017
Last Update Date : 07/17/2019

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