NPIMap

Organization Active NPI

Willie Young's Home for Young Men

Doing business as Walt's Home for Young Men

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Bakersfield, CA
National Provider Identifier
1548859556
Registry record updated Jan 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
Legal business name
WILLIE YOUNG'S HOME FOR YOUNG MEN
Doing business as
Walt's Home for Young Men
Practice address
4200 Crescent Rock LN
Bakersfield, CA 93311-2860
Phone
(661) 491-3402
Fax
(661) 491-3400
NPI assigned
Jan 14, 2021
Last updated
Jan 14, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2021

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

Authorized official

Name
Mr. Samuel Campbell Jr.NPI 1073128492
Title
President /Director
Phone
(310) 930-0199

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X NU Primary

Addresses

Primary practice location

4200 Crescent Rock LN
Bakersfield, CA 93311-2860

Mailing address

9556 Langdon Ave
North Hills, CA 91343-2103
Phone (310) 930-0199

Other names 1

  • Walt's Home for Young Men Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Walt's Home for Young Men2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1610582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610582400000",
    "number": "1548859556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9556 LANGDON AVE",
            "city": "NORTH HILLS",
            "state": "CA",
            "postal_code": "913432103",
            "telephone_number": "310-930-0199",
            "fax_number": "818-475-1914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 CRESCENT ROCK LN",
            "city": "BAKERSFIELD",
            "state": "CA",
            "postal_code": "933112860",
            "telephone_number": "661-491-3402",
            "fax_number": "661-491-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIE YOUNG'S HOME FOR YOUNG MEN",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-14",
        "last_updated": "2021-01-14",
        "certification_date": "2021-01-14",
        "status": "A",
        "authorized_official_last_name": "CAMPBELL",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "PRESIDENT /DIRECTOR",
        "authorized_official_telephone_number": "310-930-0199",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Walt's Home for Young Men",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bakersfield, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2021; 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.