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General NPI Number Information
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NPI Number | 1790147288
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Entity Type | Organization
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Legal Business Name | YOUTH VILLAGES
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Dates
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Enumeration Date | 03/23/2016
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Last Update Date | 03/23/2016
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Provider Practice Location Address
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Address Line | 2313 EXECUTIVE CIR SUITE C
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City | GREENVILLE
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State | NC
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Zip | 27834-3744
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Country | US
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Telephone | 252-215-5700
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Fax |
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Provider Business Mailing Address
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Address Line | 4 MITCHELL WOOTEN CT H
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City | KINSTON
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State | NC
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Zip | 28501-4654
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Country | US
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Telephone | 252-624-7387
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Fax |
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Authorized Official
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Title or Position | TRANSITIONAL LIVING SPECIALIST
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Name | MS. CHANTAE LYNETTE WRIGHT
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Credential |
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Telephone | 252-624-7387
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | NC
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