Provider Demographics
NPI:1184124539
Name:YOUTH FOR CHANGE
Entity type:Organization
Organization Name:YOUTH FOR CHANGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED NPI OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:LISA
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-894-5933
Mailing Address - Street 1:1128 YUBA ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-4831
Mailing Address - Country:US
Mailing Address - Phone:530-418-1001
Mailing Address - Fax:530-418-1005
Practice Address - Street 1:1128 YUBA ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-4831
Practice Address - Country:US
Practice Address - Phone:530-418-1001
Practice Address - Fax:530-418-1005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health