Healthcare Provider Details

I. General information

NPI: 1386780955
Provider Name (Legal Business Name): YOUTH FOCUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 03/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 GILCHRIST RD
BROWNS SUMMIT NC
27214-9623
US

IV. Provider business mailing address

405 PARKWAY STE A
GREENSBORO NC
27401-1693
US

V. Phone/Fax

Practice location:
  • Phone: 336-358-2151
  • Fax:
Mailing address:
  • Phone: 336-274-5909
  • Fax: 336-274-3622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL 041- 631
License Number StateNC

VIII. Authorized Official

Name: JENNIFER LEWIS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 336-274-5909