Provider Demographics
NPI:1669829685
Name:CALO YOUNG ADULT
Entity Type:Organization
Organization Name:CALO YOUNG ADULT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:UTILIZATION REVIEW DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELLIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-746-7390
Mailing Address - Street 1:PO BOX 1810
Mailing Address - Street 2:
Mailing Address - City:LAKE OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65049-1810
Mailing Address - Country:US
Mailing Address - Phone:661-622-4132
Mailing Address - Fax:573-365-2224
Practice Address - Street 1:5500 MING AVE STE 410
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-4631
Practice Address - Country:US
Practice Address - Phone:661-622-4132
Practice Address - Fax:573-365-2224
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHANGE ACADEMY AT LAKE OF THE OZARKS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-19
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness