Healthcare Provider Details

I. General information

NPI: 1568509750
Provider Name (Legal Business Name): YOUTH ENRICHMENT GROUP HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 06/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 LOCHWOOD DR
GREENSBORO NC
27406-8574
US

IV. Provider business mailing address

4299 HARBOR RIDGE DR
GREENSBORO NC
27406-8576
US

V. Phone/Fax

Practice location:
  • Phone: 336-382-6658
  • Fax: 187-784-6896
Mailing address:
  • Phone: 336-382-6658
  • Fax:

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-041-785
License Number StateNC

VIII. Authorized Official

Name: DEVOLIA SWEET
Title or Position: ASSISTANT DIRECTOR
Credential:
Phone: 336-382-6658