Provider Demographics
NPI:1811231731
Name:YOUTH SERVICE AGENCY INC.
Entity Type:Organization
Organization Name:YOUTH SERVICE AGENCY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:UHLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-347-5913
Mailing Address - Street 1:19786 BIG BEND DR
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:96022-8400
Mailing Address - Country:US
Mailing Address - Phone:530-347-5913
Mailing Address - Fax:
Practice Address - Street 1:19786 BIG BEND DR
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:CA
Practice Address - Zip Code:96022-8400
Practice Address - Country:US
Practice Address - Phone:530-347-5913
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health