Provider Demographics
NPI:1902558984
Name:CA YA SERVICES LLC
Entity Type:Organization
Organization Name:CA YA SERVICES LLC
Other - Org Name:NEWPORT INSTITUTE-FERNWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:PROCOPIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-432-4622
Mailing Address - Street 1:19200 VON KARMAN AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-8513
Mailing Address - Country:US
Mailing Address - Phone:714-202-5166
Mailing Address - Fax:
Practice Address - Street 1:5841 FERNWOOD DR
Practice Address - Street 2:
Practice Address - City:SHINGLE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95682-9760
Practice Address - Country:US
Practice Address - Phone:714-202-5166
Practice Address - Fax:844-721-8190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-21
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility