Provider Demographics
NPI:1366543928
Name:CARSON VALLEY YOUTH CAMP
Entity type:Organization
Organization Name:CARSON VALLEY YOUTH CAMP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:HILTON
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS-SOCIAL WORK
Authorized Official - Phone:775-246-7748
Mailing Address - Street 1:511 YELLOW JACKET RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:NV
Mailing Address - Zip Code:89403-8081
Mailing Address - Country:US
Mailing Address - Phone:775-246-7748
Mailing Address - Fax:775-246-7748
Practice Address - Street 1:2869 ESAW ST
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423-9059
Practice Address - Country:US
Practice Address - Phone:775-267-1775
Practice Address - Fax:775-267-1775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty