Healthcare Provider Details

I. General information

NPI: 1669970331
Provider Name (Legal Business Name): YOUTH CARE CENTER INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2018
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 S SALISBURY BLVD STE 22
SALISBURY MD
21801-7165
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: 443-914-2922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL

VIII. Authorized Official

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