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NPI Code Detail

MEDICARE: ALTERNATIVE YOUTH SERVICES, INC.

MEDICARE: ALTERNATIVE YOUTH SERVICES, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1253J00000XFoster Care Agency0001022945001SC

General Provider Information

NPI Number : 1306193123
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALTERNATIVE YOUTH SERVICES, INC.
Provider Business Mailing Address
First Line : 9901 LINN STATION RD
Second Line :
City : LOUISVILLE
State : KY
Zip : 40223-3808
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1350 CLEVELAND ST
Second Line : SUITE B
City : GREENVILLE
State : SC
Zip : 29607-2440
Country : US
Telephone Number : 864-235-5141
Fax Number :
Authorized Official
Title or Position : ASSOC. GEN. COUNSEL/PRIVACY OFFICER
Name : MS. DEENA G. OMBRES
Credential :
Telephone Number : 502-394-2100
Provider Enumeration Date : 08/10/2012
Last Update Date : 08/10/2012

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Directions to “ALTERNATIVE YOUTH SERVICES, INC. ” Practice Location

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