Healthcare Provider Details

I. General information

NPI: 1902860182
Provider Name (Legal Business Name): G4S YOUTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 E SAINT JOHNS AVE
HASTINGS FL
32145-3936
US

IV. Provider business mailing address

9609 GAYTON RD SUITE 100
RICHMOND VA
23238-4900
US

V. Phone/Fax

Practice location:
  • Phone: 904-692-2920
  • Fax: 904-692-3611
Mailing address:
  • Phone: 804-754-1100
  • Fax: 804-741-9515

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: DR. GAIL Y BROWNE
Title or Position: CEO
Credential: PH.D.
Phone: 804-754-1100