MEDICARE: NDUTIME YOUTH & FAMILY SERVICES, 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
1	320800000X	Mental Illness Community Based Residential Treatment Facility	758-14-002	VA

General Provider Information

NPI Number	:	1336222710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NDUTIME YOUTH & FAMILY SERVICES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 15808
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23227-5808
Country	:	US
Telephone Number	:	804-303-8393
Fax Number	:	804-303-8398

Provider Business Practice Location Address
First Line	:	4500 RICHMOND HENRICO TPKE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23222-1346
Country	:	US
Telephone Number	:	804-308-1652
Fax Number	:	804-308-1653

Authorized Official
Title or Position	:	ASSOCIATE DIRECTOR
Name	:	MRS. TESHANA DENISE HENDERSON
Credential	:	LCSW
Telephone Number	:	804-303-8393

Provider Enumeration Date	:	10/22/2006
Last Update Date	:	08/22/2020

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