MEDICARE: YOUTH VILLAGES

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1376763961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUTH VILLAGES

Provider Business Mailing Address
First Line	:	47 KEY CORNER RD
Second Line	:
City	:	HALLS
State	:	TN
Zip	:	38040
Country	:	US
Telephone Number	:	731-288-4623
Fax Number	:	731-288-4650

Provider Business Practice Location Address
First Line	:	47 KEY CORNER RD
Second Line	:
City	:	HALLS
State	:	TN
Zip	:	38040-5051
Country	:	US
Telephone Number	:	731-288-4623
Fax Number	:	731-288-4650

Authorized Official
Title or Position	:	PLACEMENT COORDINATOR
Name	:	MRS. CARRIE ANNE PETTY
Credential	:
Telephone Number	:	731-288-4623

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	08/22/2020

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Directions to “YOUTH VILLAGES ” Practice Location

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