Healthcare Provider Details

I. General information

NPI: 1285728220
Provider Name (Legal Business Name): DIMENSION YOUTH SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ARBOR OAK DR STE 202
ASHLAND VA
23005-2261
US

IV. Provider business mailing address

PO BOX 1435
ASHLAND VA
23005-4435
US

V. Phone/Fax

Practice location:
  • Phone: 804-752-7582
  • Fax: 804-752-7583
Mailing address:
  • Phone: 804-752-7582
  • Fax: 804-752-7583

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 Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number722-14-001
License Number StateVA

VIII. Authorized Official

Name: MR. TORECCO GREENHOW
Title or Position: DIRECTOR
Credential: MS, CSAC, QMHP
Phone: 805-752-7582