Provider Demographics
NPI:1821135849
Name:YOUTH FOR CHANGE
Entity Type:Organization
Organization Name:YOUTH FOR CHANGE
Other - Org Name:THE COMMUNITY SERVICES BUILDING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:MADISON
Authorized Official - Last Name:SILER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-877-8187
Mailing Address - Street 1:PO BOX 1476
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95967
Mailing Address - Country:US
Mailing Address - Phone:530-877-8187
Mailing Address - Fax:530-877-3020
Practice Address - Street 1:7204 SKYWAY
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969
Practice Address - Country:US
Practice Address - Phone:530-877-1965
Practice Address - Fax:530-894-5791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA04615317088081261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health