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General NPI Number Information
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NPI Number | 1487755922
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Entity Type | Organization
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Legal Business Name | INTERCEPT YOUTH SERVICES, INC.
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 2241 S PROVIDENCE RD
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City | RICHMOND
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State | VA
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Zip | 23236-2159
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Country | US
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Telephone | 804-497-7900
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Fax | 804-497-7902
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Provider Business Mailing Address
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Address Line | 5511 STAPLES MILL RD SUITE 102
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City | RICHMOND
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State | VA
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Zip | 23228-5445
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Country | US
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Telephone | 804-864-1320
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Fax | 804-864-1323
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Authorized Official
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Title or Position | REVENUE CYCLE MANAGER
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Name | YOLANDA WINFIELD
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Credential |
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Telephone | 804-807-1201
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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 | 295-14-006
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License Number State | VA
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