Provider Demographics
NPI:1720757891
Name:WILLIE YOUNG'S HOME FOR YOUNG MEN
Entity Type:Organization
Organization Name:WILLIE YOUNG'S HOME FOR YOUNG MEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:310-930-0199
Mailing Address - Street 1:9556 LANGDON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-2103
Mailing Address - Country:US
Mailing Address - Phone:310-930-0199
Mailing Address - Fax:
Practice Address - Street 1:3012 PECANGROVE DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-2331
Practice Address - Country:US
Practice Address - Phone:310-930-0199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children