Provider Demographics
NPI:1972191385
Name:LIFT UP YOUR HEAD THERAPEUTIC GROUP HOMES, INC.
Entity Type:Organization
Organization Name:LIFT UP YOUR HEAD THERAPEUTIC GROUP HOMES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:I
Authorized Official - Credentials:EXECUTIVE DIRECTOR
Authorized Official - Phone:951-634-5570
Mailing Address - Street 1:786 BROOKHURST BLVD
Mailing Address - Street 2:
Mailing Address - City:LATHROP
Mailing Address - State:CA
Mailing Address - Zip Code:95330-8984
Mailing Address - Country:US
Mailing Address - Phone:209-983-8633
Mailing Address - Fax:209-323-4452
Practice Address - Street 1:786 BROOKHURST BLVD
Practice Address - Street 2:
Practice Address - City:LATHROP
Practice Address - State:CA
Practice Address - Zip Code:95330-8984
Practice Address - Country:US
Practice Address - Phone:209-983-8633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-02
Last Update Date:2021-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children