Provider Demographics
NPI:1356852636
Name:PARADISE OAKS YOUTH SERVICES
Entity Type:Organization
Organization Name:PARADISE OAKS YOUTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QUALITY ASSURANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-967-6253
Mailing Address - Street 1:6060 SUNRISE VISTA DR STE 2100
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-7068
Mailing Address - Country:US
Mailing Address - Phone:916-967-6253
Mailing Address - Fax:916-967-9413
Practice Address - Street 1:7331 HAZEL AVE
Practice Address - Street 2:
Practice Address - City:ORANGEVALE
Practice Address - State:CA
Practice Address - Zip Code:95662-2440
Practice Address - Country:US
Practice Address - Phone:916-967-6253
Practice Address - Fax:916-967-9413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-13
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA347006002320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness