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General NPI Number Information
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NPI Number | 1730608217
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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 | 09/15/2017
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Last Update Date | 11/09/2025
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Provider Practice Location Address
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Address Line | 5673 AIRPORT RD
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City | ROANOKE
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State | VA
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Zip | 24012-1119
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Country | US
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Telephone | 540-523-8080
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Fax | 540-512-9775
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Provider Business Mailing Address
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Address Line | 5511 STAPLES MILL RD STE 102
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City | HENRICO
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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 | 804-422-0840
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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 | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment 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 | 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 #3
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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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Taxonomy #4
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number | 100032497
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License Number State | VA
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