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
1	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	347003686	CA

General Provider Information

NPI Number	:	1912361932
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	:	8208 OLIVINE AVE
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-3223
Country	:	US
Telephone Number	:	916-967-6253
Fax Number	:	916-967-9413

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	LAYNEE KUHN
Credential	:
Telephone Number	:	916-967-6253

Provider Enumeration Date	:	04/06/2016
Last Update Date	:	07/17/2019

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