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General NPI Number Information
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NPI Number | 1710528252
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Entity Type | Organization
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Legal Business Name | CT YA SERVICES LLC
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Dates
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Enumeration Date | 10/07/2019
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 3236 CONGRESS ST
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City | FAIRFIELD
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State | CT
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Zip | 06824-2034
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Country | US
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Telephone | 714-202-5166
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Fax | 844-721-8190
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Provider Business Mailing Address
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Address Line | L-4057
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City | COLUMBUS
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State | OH
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Zip | 43260-4057
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Country | US
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Telephone | 714-202-5166
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Fax | 844-721-8190
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Authorized Official
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Title or Position | CHIEF LEGAL & DEVELOPMENT OFFICER
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Name | KEITH THOMPSON
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Credential |
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Telephone | 949-432-4622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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