{
"Npi": {
"NPI": "1518448331",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "INTERCEPT YOUTH SERVICES, INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5511 STAPLES MILL RD STE 102",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RICHMOND",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "23228-5445",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "804-612-3317",
"MailingAddressFaxNumber": "804-422-0840",
"FirstLinePracticeLocationAddress": "105 W PINE ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WYTHEVILLE",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "24382-1937",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "540-759-8464",
"PracticeLocationAddressFaxNumber": "276-706-8555",
"EnumerationDate": "08/29/2018",
"LastUpdateDate": "03/25/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WINFIELD",
"AuthorizedOfficialFirstName": "YOLANDA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "REVENUE CYCLE MANAGER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "804-807-1201",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": "295-05-001",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}