Provider Demographics
NPI:1699389452
Name:MILLIE'S YOUTH SERVICES, INC.
Entity Type:Organization
Organization Name:MILLIE'S YOUTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-772-8458
Mailing Address - Street 1:21 CAMISA CIR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-4919
Mailing Address - Country:US
Mailing Address - Phone:510-772-8458
Mailing Address - Fax:
Practice Address - Street 1:2512 HAVENSCOURT BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-1935
Practice Address - Country:US
Practice Address - Phone:510-568-4601
Practice Address - Fax:510-568-4339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-31
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children