Provider Demographics
NPI:1063822492
Name:TAHOE YOUTH & FAMILY SERVICES
Entity Type:Organization
Organization Name:TAHOE YOUTH & FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CROFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-782-4202
Mailing Address - Street 1:1512 US HIGHWAY 395 N
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89410-5282
Mailing Address - Country:US
Mailing Address - Phone:775-782-4202
Mailing Address - Fax:775-782-5055
Practice Address - Street 1:100 FOOTHILL RD.
Practice Address - Street 2:BUILDING D, ROOM 5
Practice Address - City:MARKLEEVILLE
Practice Address - State:CA
Practice Address - Zip Code:96120-9631
Practice Address - Country:US
Practice Address - Phone:775-782-4202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-07
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC0636452251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1265625636OtherMEDI-CAL
NV1700173077Medicaid