Healthcare Provider Details

I. General information

NPI: 1639605843
Provider Name (Legal Business Name): JUST IN TIME YOUTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2017
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432 W 5TH ST
BURLINGTON NC
27215-3832
US

IV. Provider business mailing address

PO BOX 2162
BURLINGTON NC
27216-2162
US

V. Phone/Fax

Practice location:
  • Phone: 336-437-2350
  • Fax: 336-270-4578
Mailing address:
  • Phone: 336-437-2350
  • Fax: 336-270-4578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. LISA LYNETTE BROWN
Title or Position: CEO/DIRECTOR
Credential: BS
Phone: 336-437-2350