Provider Demographics
NPI:1356748297
Name:YOUTH FOR CHANGE
Entity type:Organization
Organization Name:YOUTH FOR CHANGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NPI CONTACT
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 1:578 RIO LINDO AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1800
Mailing Address - Country:US
Mailing Address - Phone:530-894-5933
Mailing Address - Fax:530-894-5791
Practice Address - Street 1:2854 OLIVE HWY STE B&C
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-6112
Practice Address - Country:US
Practice Address - Phone:530-894-5933
Practice Address - Fax:530-894-5791
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YOUTH FOR CHANGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-20
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health