Healthcare Provider Details

I. General information

NPI: 1174694913
Provider Name (Legal Business Name): YOUTH VILLAGES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 09/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4685 DORSETT SHOALS RD
DOUGLASVILLE GA
30135-4921
US

IV. Provider business mailing address

3320 BROTHER BLVD
BARTLETT TN
38133-8950
US

V. Phone/Fax

Practice location:
  • Phone: 770-942-2391
  • Fax:
Mailing address:
  • Phone: 901-251-4840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: DENEEN M ALEXANDER
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 901-251-4840