MEDICARE: YOLO WAYFARER CENTER (CHRISTIAN MISSION)

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	305S00000X	Point of Service	570008BN	CA

General Provider Information

NPI Number	:	1922466226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOLO WAYFARER CENTER (CHRISTIAN MISSION)

Provider Business Mailing Address
First Line	:	PO BOX 1248
Second Line	:
City	:	WOODLAND
State	:	CA
Zip	:	95776-1248
Country	:	US
Telephone Number	:	530-661-1218
Fax Number	:	530-661-2494

Provider Business Practice Location Address
First Line	:	207 4TH ST
Second Line	:
City	:	WOODLAND
State	:	CA
Zip	:	95695-3501
Country	:	US
Telephone Number	:	530-661-1218
Fax Number	:	530-661-2494

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DOUG ZECK
Credential	:
Telephone Number	:	530-661-1218

Provider Enumeration Date	:	02/02/2016
Last Update Date	:	01/09/2020

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