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General NPI Number Information
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NPI Number | 1508161175
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Entity Type | Organization
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Legal Business Name | VIRGINIA YOUTH OUTREACH SERVICES, INC.
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Dates
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Enumeration Date | 01/12/2011
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Last Update Date | 01/12/2011
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Provider Practice Location Address
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Address Line | 1012 W 3RD ST STE D
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City | FARMVILLE
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State | VA
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Zip | 23901-3070
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Country | US
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Telephone | 804-484-5539
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 13751
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City | RICHMOND
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State | VA
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Zip | 23901-8751
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Country | US
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Telephone | 804-484-5539
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. RANDY REDD
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Credential |
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Telephone | 804-484-5539
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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 |
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License Number State |
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