Healthcare Provider Details

I. General information

NPI: 1295972248
Provider Name (Legal Business Name): YORE ACADEMY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2009
Last Update Date: 01/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 CROSSWIND DRIVE
FAIRMONT WV
26554
US

IV. Provider business mailing address

7 CROSSWIND DRIVE
FAIRMONT WV
26554
US

V. Phone/Fax

Practice location:
  • Phone: 304-363-3341
  • Fax: 304-363-3342
Mailing address:
  • Phone: 304-363-3341
  • Fax: 304-363-3342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number403
License Number StateWV

VIII. Authorized Official

Name: STEVEN FAIRLEY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 304-363-3341