MEDICARE: PARAMOUNT YOUTH 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	320800000X	Mental Illness Community Based Residential Treatment Facility	37214001	VA

General Provider Information

NPI Number	:	1285838797
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARAMOUNT YOUTH SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 12152
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23541-0152
Country	:	US
Telephone Number	:	757-625-0504
Fax Number	:

Provider Business Practice Location Address
First Line	:	3115 LORRAINE AVE
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23509-1127
Country	:	US
Telephone Number	:	757-625-0504
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. DAMON SUTTON
Credential	:	M.S.
Telephone Number	:	757-623-3184

Provider Enumeration Date	:	06/11/2007
Last Update Date	:	08/22/2020

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