MEDICARE: WE CARE YOUTH SERVICES, LLC

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
1	320800000X	Mental Illness Community Based Residential Treatment Facility	1198-14-001	VA

General Provider Information

NPI Number	:	1508000753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WE CARE YOUTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	2431 HICKS RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23235-5420
Country	:	US
Telephone Number	:	804-658-1368
Fax Number	:

Provider Business Practice Location Address
First Line	:	2431 HICKS RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23235-5420
Country	:	US
Telephone Number	:	804-658-1368
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER
Name	:	MR. JAMES FLOYD HARRIS
Credential	:
Telephone Number	:	804-795-2610

Provider Enumeration Date	:	04/30/2009
Last Update Date	:	04/30/2009

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