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General NPI Number Information
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NPI Number | 1053178574
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Entity Type | Organization
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Legal Business Name | YOUTH EMPORIUM INC
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Dates
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Enumeration Date | 03/01/2024
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Last Update Date | 03/01/2024
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Provider Practice Location Address
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Address Line | 3400 CHAPEL HILL RD
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-1739
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Country | US
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Telephone | 678-521-5245
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Fax | 678-812-3633
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Provider Business Mailing Address
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Address Line | 3400 CHAPEL HILL RD
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-1739
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Country | US
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Telephone | 678-521-5245
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Fax | 678-812-3633
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Authorized Official
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Title or Position | PRESIDENT & EX. DIRECTOR
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Name | DR. BRENDA L HILLMAN
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Credential | DR, MSPSL, BA
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Telephone | 678-521-5245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 177F00000X
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Taxonomy Name | Lodging Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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Taxonomy #3
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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Taxonomy #4
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number |
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Taxonomy #5
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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Taxonomy #6
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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Taxonomy #7
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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