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NPI Code Detail

MEDICARE: FAMILIES & YOUTH, INC

MEDICARE: FAMILIES & YOUTH, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1322D00000XEmotionally Disturbed Childrens' Residential Treatment Facility1077ANM
2251S00000XCommunity/Behavioral Health Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003031436
Entity Type Code : Organization
Provider Name (Legal Business Name) : FAMILIES & YOUTH, INC
Provider Business Mailing Address
First Line : PO BOX 1868
Second Line :
City : LAS CRUCES
State : NM
Zip : 88004-1868
Country : US
Telephone Number : 505-522-4004
Fax Number : 505-522-9017
Provider Business Practice Location Address
First Line : 1320 S. SOLANO DRIVE
Second Line :
City : LAS CRUCES
State : NM
Zip : 88001-3758
Country : US
Telephone Number : 505-522-4004
Fax Number : 505-522-9017
Authorized Official
Title or Position : CEO
Name : MR. BRIAN KAVANAUGH
Credential : MPA
Telephone Number : 575-644-0485
Provider Enumeration Date : 04/13/2007
Last Update Date : 04/12/2023

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Directions to “FAMILIES & YOUTH, INC ” Practice Location

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