Healthcare Provider Details

I. General information

NPI: 1508241639
Provider Name (Legal Business Name): YELVERTON'S ENRICHMENT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2015
Last Update Date: 09/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 EVENING STAR DR
APEX NC
27502-4029
US

IV. Provider business mailing address

4805 GREEN RD SUITE 103
RALEIGH NC
27616-2848
US

V. Phone/Fax

Practice location:
  • Phone: 919-303-5002
  • Fax:
Mailing address:
  • Phone: 919-872-6220
  • Fax: 919-872-6223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberMHL-092-923
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL-092-923
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: VICKIE SMITH YELVERTON
Title or Position: EXECUTIVE PROGRAM DIRECTOR
Credential:
Phone: 919-961-5123