Provider Demographics
NPI:1780037523
Name:PRO YOUTH CENTERS
Entity Type:Organization
Organization Name:PRO YOUTH CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:MIKI
Authorized Official - Middle Name:
Authorized Official - Last Name:MCREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-469-6029
Mailing Address - Street 1:28816 CONEJO VIEW DR
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-3367
Mailing Address - Country:US
Mailing Address - Phone:818-889-0091
Mailing Address - Fax:818-532-7919
Practice Address - Street 1:1783 TEMPLE AVE
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-3367
Practice Address - Country:US
Practice Address - Phone:805-388-1035
Practice Address - Fax:805-388-1062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-17
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA565801695322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children