Healthcare Provider Details

I. General information

NPI: 1770878894
Provider Name (Legal Business Name): ALTERNATIVE YOUTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2011
Last Update Date: 07/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 GOOSE HOLLOW RD
REYNOLDS GA
31076-3505
US

IV. Provider business mailing address

9901 LINN STATION RD
LOUISVILLE KY
40223-3808
US

V. Phone/Fax

Practice location:
  • Phone: 478-847-2900
  • Fax:
Mailing address:
  • Phone: 502-394-2100
  • Fax: 502-394-2285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberCCI001717
License Number StateGA

VIII. Authorized Official

Name: MS. DEENA G. OMBRES
Title or Position: ASSOC. GEN. COUNSEL/PRIVACY OFFICER
Credential:
Phone: 502-394-2387