Provider Demographics
NPI:1639179658
Name:DIOGENES YOUTH SERVICES INC
Entity Type:Organization
Organization Name:DIOGENES YOUTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:BUETO
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:916-369-5447
Mailing Address - Street 1:9719 LINCOLN VILLAGE DR
Mailing Address - Street 2:STE 110
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-3303
Mailing Address - Country:US
Mailing Address - Phone:916-369-5447
Mailing Address - Fax:916-369-5389
Practice Address - Street 1:9719 LINCOLN VILLAGE DR
Practice Address - Street 2:STE 203
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-3303
Practice Address - Country:US
Practice Address - Phone:916-369-5447
Practice Address - Fax:916-369-5389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA340062AN261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder