Provider Demographics
NPI:1790805216
Name:TAHOE YOUTH AND FAMILY SERVICES
Entity Type:Organization
Organization Name:TAHOE YOUTH AND FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHEYANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-541-2445
Mailing Address - Street 1:1021 FREMONT AVENUE
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-8136
Mailing Address - Country:US
Mailing Address - Phone:530-541-2445
Mailing Address - Fax:530-541-0517
Practice Address - Street 1:1021 FREMONT AVENUE
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-8136
Practice Address - Country:US
Practice Address - Phone:530-541-2445
Practice Address - Fax:530-541-0517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA090906000OtherMEDI CAL PROVIDER ID