NPIMap

Organization Active NPI

Canyon Oaks Youth Center

  • Mental Illness Community Based Residential Treatment Facility
  • Redwood City, CA
National Provider Identifier
1497085138
Registry record updated Dec 31, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
CANYON OAKS YOUTH CENTER
Practice address
400 Edmonds Rd
Redwood City, CA 94062-3803
Phone
(650) 839-1810
NPI assigned
Dec 31, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2009

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

Authorized official

Name
Mr. Tim R. Holechek, LCSW
Title
Residental Counselor Relief
Phone
(650) 839-1810

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X Primary

Addresses

Primary practice location

400 Edmonds Rd
Redwood City, CA 94062-3803

Mailing address

9031 Castlewood St
Oakland, CA 94605-4407
Phone (510) 213-2592

National Provider Directory

National Provider Directory
Tax ID family
Urgent Care at Memorial Hospital8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

400 Edmonds Rd
Redwood City, CA 94062
Phone (650) 839-1810

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1262217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262217600000",
    "number": "1497085138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9031 CASTLEWOOD ST",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946054407",
            "telephone_number": "510-213-2592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 EDMONDS RD",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "940623803",
            "telephone_number": "650-839-1810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYON OAKS YOUTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-31",
        "last_updated": "2009-12-31",
        "status": "A",
        "authorized_official_last_name": "HOLECHEK",
        "authorized_official_first_name": "TIM",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "RESIDENTAL COUNSELOR RELIEF",
        "authorized_official_telephone_number": "650-839-1810",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redwood City, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2009; 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.