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General NPI Number Information
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NPI Number | 1912020678
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Entity Type | Organization
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Legal Business Name | JOHNNYS HEROES YOUTH AND FAMILY SERVICES, INC.
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1026 MAIN STREET
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City | DANVILLE
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State | VA
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Zip | 24541
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Country | US
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Telephone | 434-791-4208
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Fax | 434-791-4206
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Provider Business Mailing Address
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Address Line | P.O. BOX 5549
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City | RICHMOND
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State | VA
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Zip | 23220
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Country | US
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Telephone | 804-370-9963
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Fax | 804-782-0186
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Authorized Official
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Title or Position | C.A.O.
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Name | MR. JOHN SYLVESTER NEWMAN JR.
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Credential |
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Telephone | 804-370-9963
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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 | 662-14-001
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License Number State | VA
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