MEDICARE: YELVERTON'S ENRICHMENT 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	MHL-092-927	NC
2	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	MHL-092-927	NC

General Provider Information

NPI Number	:	1437535598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YELVERTON'S ENRICHMENT SERVICES, INC.

Provider Business Mailing Address
First Line	:	4805 GREEN RD
Second Line	:	SUITE 103
City	:	RALEIGH
State	:	NC
Zip	:	27616-2848
Country	:	US
Telephone Number	:	919-872-6220
Fax Number	:	919-872-6223

Provider Business Practice Location Address
First Line	:	7625 MINE VALLEY RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27615-6017
Country	:	US
Telephone Number	:	919-917-7005
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE PROGRAM DIRECTOR
Name	:	VICKIE SMITH YELVERTON
Credential	:
Telephone Number	:	919-961-5123

Provider Enumeration Date	:	07/30/2015
Last Update Date	:	09/02/2015

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