Healthcare Provider Details

I. General information

NPI: 1912542473
Provider Name (Legal Business Name): YOUTH CARE CENTER INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2019
Last Update Date: 11/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E MAIN ST STE B
SALISBURY MD
21801-5139
US

IV. Provider business mailing address

3917 MARKET ST
SNOW HILL MD
21863-4413
US

V. Phone/Fax

Practice location:
  • Phone: 443-914-2922
  • Fax:
Mailing address:
  • Phone: 443-944-1118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: SHAWN JOHNSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 443-944-1118