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General NPI Number Information
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NPI Number | 1578074142
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Entity Type | Organization
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Legal Business Name | RESTORED YOUTH SERVICES, LLC
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Dates
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Enumeration Date | 10/23/2017
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Last Update Date | 10/23/2017
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Provider Practice Location Address
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Address Line | 305 D ST
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City | N WILKESBORO
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State | NC
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Zip | 28659-4345
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Country | US
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Telephone | 335-990-0688
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Fax | 336-990-0687
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Provider Business Mailing Address
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Address Line | 4223 BENTLEY DR
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City | RANDLEMAN
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State | NC
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Zip | 27317-8306
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Country | US
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Telephone | 336-302-9451
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MELISSA RUNETTA PEARSON
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Credential | BS
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Telephone | 336-302-9451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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