Provider Demographics
NPI:1780057521
Name:DHHS IHS CAO DESERT SAGE YOUTH WELLNESS CENTER
Entity type:Organization
Organization Name:DHHS IHS CAO DESERT SAGE YOUTH WELLNESS CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CALIFORNIA AREA DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-930-3981
Mailing Address - Street 1:650 CAPITOL MALL RM 7100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-4706
Mailing Address - Country:US
Mailing Address - Phone:916-930-3981
Mailing Address - Fax:
Practice Address - Street 1:39990 FAURE RD
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-9408
Practice Address - Country:US
Practice Address - Phone:916-930-3981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-02
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children