=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780844076
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTERCEPT YOUTH SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2008
-----------------------------------------------------
Last Update Date | 03/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8401 COURTHOUSE RD
-----------------------------------------------------
City | CHESTERFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23832-6313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-425-9384
-----------------------------------------------------
Fax | 804-425-9386
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5511 STAPLES MILL RD SUITE 102
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23228-5445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-440-3700
-----------------------------------------------------
Fax | 804-440-3711
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REVENUE CYCLE MANAGER
-----------------------------------------------------
Name | MRS. YOLANDA WINFIELD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 48-807-1201
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 322D00000X
-----------------------------------------------------
Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 320800000X
-----------------------------------------------------
Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------