Van Horn Youth Center

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

License

ASW 20410 Issued in CA

Legal business name

VAN HORN YOUTH CENTER

Practice address

22964 Pablo
Nuevo, CA 92567-9635

Phone

(951) 928-5568

NPI assigned

Sep 20, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Samantha Lillo

Title

Clinical Therapist

Phone

(951) 928-5568

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1356448583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22964 PABLO",
            "city": "NUEVO",
            "state": "CA",
            "postal_code": "925679635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22964 PABLO",
            "city": "NUEVO",
            "state": "CA",
            "postal_code": "925679635",
            "telephone_number": "951-928-5568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VAN HORN YOUTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LILLO",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_title_or_position": "CLINICAL THERAPIST",
        "authorized_official_telephone_number": "951-928-5568"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "CA",
            "license": "ASW 20410",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• St Agnes Non-Emergency Medical Transportation LLC (Vega Transportation)
• Cassandra Tejera, LMFT
• Maria Terminel
• The Boxy Foundation
• Tmi Physical Therapy, Inc.
• Lindsey Van Liew, PA-C
• Ryan Van Liew, PA-C
• Cynthia Wakugawa
• West Coast Dental Group
• Wylie Center

• Mental Illness Community Based Residential Treatment Facility in Nuevo, CA
• Providers in Nuevo, CA by specialty
• Mental Illness Community Based Residential Treatment Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.