Healthcare Provider Details

I. General information

NPI: 1215268693
Provider Name (Legal Business Name): YOUTH RESIDENTIAL SERVICES OF VIRGINIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2010
Last Update Date: 02/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7303 HULL STREET RD
RICHMOND VA
23235-5805
US

IV. Provider business mailing address

PO BOX 74100
RICHMOND VA
23236-0002
US

V. Phone/Fax

Practice location:
  • Phone: 804-230-4760
  • Fax: 804-230-4766
Mailing address:
  • Phone: 804-230-4760
  • Fax: 804-230-4766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number601-02-014
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number601-14-003
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number601-14-005
License Number StateVA

VIII. Authorized Official

Name: MR. STEPHEN ALEXANDER PARSON JR.
Title or Position: CEO
Credential:
Phone: 804-230-4760