Provider Demographics
NPI:1619162112
Name:LAMERCIEYOUTHANDADULTSERVICES, INCORPORATED
Entity Type:Organization
Organization Name:LAMERCIEYOUTHANDADULTSERVICES, INCORPORATED
Other - Org Name:LAMERCIEYOUTH HOMES ' I'M NOT ALONE' PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-665-2828
Mailing Address - Street 1:2251 FLORIN RD STE 35
Mailing Address - Street 2:4328 CARMELO OAKS COURT
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-4498
Mailing Address - Country:US
Mailing Address - Phone:916-665-2828
Mailing Address - Fax:
Practice Address - Street 1:2251 FLORIN RD STE 35
Practice Address - Street 2:4328 CARMELO OAKS COURT
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95822-4498
Practice Address - Country:US
Practice Address - Phone:916-665-2828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-08
Last Update Date:2007-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA340076AN/BN324500000X
CA322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children