# CATHLIC CHARITIES CYO

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659670008
- **Authorized official:** MS. THESIA NICHELLE DAVIS (PROGRAM SUPERVISOR)
- **Authorized official phone:** (415) 507-2000

## Contact information

- **Practice address:** 1 ST.VINCENT DR, SAN RAFAEL, CA 94903
- **Practice address phone:** (415) 507-2000
- **Mailing address:** 18 W LAKE DR, ANTIOCH, CA 94509-1939

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | — | CA | Yes |

## Other

- **Enumeration date:** 03/24/2011
- **Last updated:** 07/21/2022