Healthcare Provider Details

I. General information

NPI: 1497958524
Provider Name (Legal Business Name): JUST IN TIME YOUTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 DOGWOOD DR
BURLINGTON NC
27215-5303
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: 336-578-3159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL-001-149
License Number StateNC

VIII. Authorized Official

Name: MISS LISA LYNETTE BROWN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: CEO
Phone: 336-437-2350