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General NPI Number Information
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NPI Number | 1184950412
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Entity Type | Organization
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Legal Business Name | JOHNNY'S HEROES YOUTH & FAMILY SERVICES, INC.
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Dates
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Enumeration Date | 10/21/2009
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Last Update Date | 10/21/2009
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Provider Practice Location Address
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Address Line | 502 FRANKLIN STREET
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City | DENVILLE
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State | VA
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Zip | 24541-1526
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Country | US
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Telephone | 434-792-9070
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Fax | 434-792-9071
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Provider Business Mailing Address
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Address Line | P O BOX 5549
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City | RICHMOND
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State | VA
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Zip | 23220-0549
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Country | US
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Telephone | 804-782-2255
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Fax | 804-782-0186
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Authorized Official
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Title or Position | CEO
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Name | JOHN S. NEWMAN JR.
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Credential |
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Telephone | 804-370-9963
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 662-02-029
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License Number State |
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