Healthcare Provider Details

I. General information

NPI: 1932334000
Provider Name (Legal Business Name): INTERCEPT YOUTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5673 AIRPORT RD
ROANOKE VA
24012-1119
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 804-440-3700
  • Fax:
Mailing address:
  • Phone: 804-864-1320
  • Fax: 804-864-1323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License NumberCO-293-09
License Number StateVA

VIII. Authorized Official

Name: YOLANDA WINFIELD
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 804-807-1201