Provider Demographics
NPI:1295407849
Name:PROGRESS RANCH TREATMENT SERVICES FOR CHILDREN
Entity Type:Organization
Organization Name:PROGRESS RANCH TREATMENT SERVICES FOR CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:ELSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:530-753-2566
Mailing Address - Street 1:PO BOX 1287
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95617-1287
Mailing Address - Country:US
Mailing Address - Phone:530-753-2566
Mailing Address - Fax:
Practice Address - Street 1:1106 CHESTNUT LANE
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-9561
Practice Address - Country:US
Practice Address - Phone:530-753-2566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-01
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA577005990OtherCALIFORNIA DEPARTMENT OF SOCIAL SERVICES