Healthcare Provider Details

I. General information

NPI: 1326232240
Provider Name (Legal Business Name): YOUTH HOME INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5109 W 23RD ST
LITTLE ROCK AR
72204-5101
US

IV. Provider business mailing address

5109 W 23RD ST
LITTLE ROCK AR
72204-5101
US

V. Phone/Fax

Practice location:
  • Phone: 501-663-7667
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: SCEALITA DRENNON
Title or Position: BEHAVIOR SPECIALIST
Credential:
Phone: 501-663-7667