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General NPI Number Information
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NPI Number | 1083831168
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Entity Type | Organization
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Legal Business Name | YOUTH HAVEN SERVICES, INC.
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 10/21/2020
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Provider Practice Location Address
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Address Line | 1115 ROSEMONT DR
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City | REIDSVILLE
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State | NC
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Zip | 27320-4405
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Country | US
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Telephone | 336-349-2233
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Fax | 336-634-0444
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Provider Business Mailing Address
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Address Line | 229 TURNER DR
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City | REIDSVILLE
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State | NC
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Zip | 27320-5736
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Country | US
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Telephone | 336-349-2233
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Fax | 336-634-0444
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. DAWN TUCKER JOHNSON
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Credential | LCSW
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Telephone | 336-349-2233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | MHL079073
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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