NPIMap

Organization Active NPI

Cathlic Charities Cyo

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • San Rafael, CA
National Provider Identifier
1659670008
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
Legal business name
CATHLIC CHARITIES CYO
Practice address
1 St.Vincent Dr
San Rafael, CA 94903
Phone
(415) 507-2000
NPI assigned
Mar 24, 2011
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Ms. Thesia Nichelle Davis
Title
Program Supervisor
Phone
(415) 507-2000

Specialties & licenses 1

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

Addresses

Primary practice location

1 St.Vincent Dr
San Rafael, CA 94903

Mailing address

18 W Lake Dr
Antioch, CA 94509-1939

National Provider Directory

National Provider Directory
Tax ID family
Catholic Charities Cyo of the Archdiocese of San Francisco11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1300924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1659670008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 W LAKE DR",
            "city": "ANTIOCH",
            "state": "CA",
            "postal_code": "945091939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 ST.VINCENT DR",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "94903",
            "telephone_number": "415-507-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CATHLIC CHARITIES CYO",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-24",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "THESIA",
        "authorized_official_middle_name": "NICHELLE",
        "authorized_official_title_or_position": "PROGRAM SUPERVISOR",
        "authorized_official_telephone_number": "415-507-2000",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Rafael, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.