Provider Demographics
NPI:1942618301
Name:PSYNERGY PROGRAMS, INC.
Entity Type:Organization
Organization Name:PSYNERGY PROGRAMS, INC.
Other - Org Name:NUEVA VISTA SACRAMENTO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATION OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ARTURO
Authorized Official - Middle Name:MEDRANO
Authorized Official - Last Name:URIBE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:408-465-8280
Mailing Address - Street 1:18225 HALE AVE
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-3547
Mailing Address - Country:US
Mailing Address - Phone:408-465-8280
Mailing Address - Fax:408-465-8295
Practice Address - Street 1:4604 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-4520
Practice Address - Country:US
Practice Address - Phone:408-465-8280
Practice Address - Fax:408-465-8295
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PSYNERGY PROGRAMS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-30
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA347005533320800000X
CA340308522320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness