MEDICARE: EZETT YOUTH & 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	251S00000X	Community/Behavioral Health Agency	1592	VA

General Provider Information

NPI Number	:	1437401403
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EZETT YOUTH & FAMILY SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 201
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23075-0201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	209 ELSING GREEN WAY
Second Line	:
City	:	HIGHLAND SPRINGS
State	:	VA
Zip	:	23075-2455
Country	:	US
Telephone Number	:	804-252-9391
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF SERVICES
Name	:	AMI WILLIAMS
Credential	:
Telephone Number	:	804-252-9391

Provider Enumeration Date	:	10/15/2012
Last Update Date	:	10/15/2012

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