MEDICARE: INTEGRATED 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
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center	493	OH
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	11001	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710907597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED YOUTH SERVICES INC

Provider Business Mailing Address
First Line	:	1321 RESEARCH PARK DRIVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45432
Country	:	US
Telephone Number	:	937-427-3837
Fax Number	:	937-427-4516

Provider Business Practice Location Address
First Line	:	1321 RESEARCH PARK DRIVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45432
Country	:	US
Telephone Number	:	937-427-3837
Fax Number	:	937-427-4516

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. DAVID D NUSCHER
Credential	:
Telephone Number	:	937-427-3837

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	09/11/2025

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