Provider Demographics
NPI:1083010409
Name:CHAMBERLAIN'S YOUTH SERVICES
Entity Type:Organization
Organization Name:CHAMBERLAIN'S YOUTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR. MENTAL HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:831-636-2121
Mailing Address - Street 1:1850 SAN BENITO ST
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-4899
Mailing Address - Country:US
Mailing Address - Phone:831-636-2121
Mailing Address - Fax:831-636-5296
Practice Address - Street 1:1850 SAN BENITO ST
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-4899
Practice Address - Country:US
Practice Address - Phone:831-636-2121
Practice Address - Fax:831-636-5296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-12
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA355201170322D00000X
322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children