MEDICARE: HOYLETON YOUTH AND FAMILY SERVICES

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
1	251C00000X	Developmentally Disabled Services Day Training Agency
2	253J00000X	Foster Care Agency

General Provider Information

NPI Number	:	1083073977
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOYLETON YOUTH AND FAMILY SERVICES

Provider Business Mailing Address
First Line	:	350 N MAIN ST
Second Line	:
City	:	HOYLETON
State	:	IL
Zip	:	62803-2006
Country	:	US
Telephone Number	:	618-493-7382
Fax Number	:	618-493-7504

Provider Business Practice Location Address
First Line	:	8 EXECUTIVE DR
Second Line	:	SUITE 200
City	:	FAIRVIEW HEIGHTS
State	:	IL
Zip	:	62208-1345
Country	:	US
Telephone Number	:	618-875-0673
Fax Number	:	618-875-0861

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. CHRISTOPHER L. COX
Credential	:	MSW, LCSW
Telephone Number	:	618-493-7382

Provider Enumeration Date	:	02/19/2016
Last Update Date	:	02/19/2016

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