MEDICARE: YOUTH SERVICES SYSTEM, 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	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	09GR003	WV

General Provider Information

NPI Number	:	1376783613
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUTH SERVICES SYSTEM, INC.

Provider Business Mailing Address
First Line	:	1000 CHAPLINE ST
Second Line	:
City	:	WHEELING
State	:	WV
Zip	:	26003-2902
Country	:	US
Telephone Number	:	304-233-9627
Fax Number	:	304-233-0056

Provider Business Practice Location Address
First Line	:	1000 CHAPLINE ST
Second Line	:	1A ORCHARD PARK RD.
City	:	WHEELING
State	:	WV
Zip	:	26003-2902
Country	:	US
Telephone Number	:	304-233-9627
Fax Number	:	304-233-0056

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	JOHN MOSES
Credential	:
Telephone Number	:	304-233-9627

Provider Enumeration Date	:	02/26/2009
Last Update Date	:	02/26/2009

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