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General NPI Number Information
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NPI Number | 1932334000
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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 | 05/19/2009
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Last Update Date | 07/03/2025
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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 | 804-440-3700
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Fax |
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Provider Business Mailing Address
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Address Line | 5511 STAPLES MILL RD SUITE 102
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City | RICHMOND
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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 | 804-864-1323
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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 | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number | CO-293-09
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License Number State | VA
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