Provider Demographics
NPI:1609122423
Name:YOUTH JUSTICE INSTITUTE
Entity Type:Organization
Organization Name:YOUTH JUSTICE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GENA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTRO RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LFMT
Authorized Official - Phone:415-753-7670
Mailing Address - Street 1:PO BOX 31733
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-0733
Mailing Address - Country:US
Mailing Address - Phone:415-753-7662
Mailing Address - Fax:415-753-4464
Practice Address - Street 1:375 WOODSIDE AVE
Practice Address - Street 2:W2
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94127-1221
Practice Address - Country:US
Practice Address - Phone:415-753-7662
Practice Address - Fax:415-753-7662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 49717251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health