Healthcare Provider Details

I. General information

NPI: 1407998883
Provider Name (Legal Business Name): YOUTH VILLAGES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7426 MEMPHIS ARLINGTON RD
MEMPHIS TN
38135-1908
US

IV. Provider business mailing address

7426 MEMPHIS ARLINGTON RD
MEMPHIS TN
38135-1908
US

V. Phone/Fax

Practice location:
  • Phone: 901-252-7788
  • Fax: 901-252-7990
Mailing address:
  • Phone: 901-252-7788
  • Fax: 901-252-7990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. CONSTANCE D. MASON
Title or Position: SENIOR RESIDENTIAL COUNSELOR
Credential: M.S.W.
Phone: 901-252-7788