Organization
CATHLIC CHARITIES CYO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. THESIA NICHELLE DAVIS (PROGRAM SUPERVISOR)
(415) 507-2000
Entity
Organization
Contact information
Practice address
1 ST.VINCENT DR, SAN RAFAEL, CA 94903
(415) 507-2000
Mailing address
18 W LAKE DR, ANTIOCH, CA 94509-1939
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
CA
Other
Enumeration date
03/24/2011
Last updated
07/21/2022
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