Healthcare Provider Details

I. General information

NPI: 1386704450
Provider Name (Legal Business Name): YOUTH HOMES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E 5TH ST SUITE 330
CHARLOTTE NC
28202-3031
US

IV. Provider business mailing address

601 E 5TH ST SUITE 330
CHARLOTTE NC
28202-3031
US

V. Phone/Fax

Practice location:
  • Phone: 704-334-9955
  • Fax: 704-375-7497
Mailing address:
  • Phone: 704-334-9955
  • Fax: 704-375-7497

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 Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL-060-061
License Number StateNC

VIII. Authorized Official

Name: MR. FRANK H CRAWFORD JR.
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 704-334-9955