Healthcare Provider Details

I. General information

NPI: 1780844076
Provider Name (Legal Business Name): INTERCEPT YOUTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 COURTHOUSE RD
CHESTERFIELD VA
23832-6313
US

IV. Provider business mailing address

5511 STAPLES MILL RD SUITE 102
RICHMOND VA
23228-5445
US

V. Phone/Fax

Practice location:
  • Phone: 804-425-9384
  • Fax: 804-425-9386
Mailing address:
  • Phone: 804-440-3700
  • Fax: 804-440-3711

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 Number
License Number State

VIII. Authorized Official

Name: MRS. YOLANDA WINFIELD
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 48-807-1201