MEDICARE: INTERCEPT YOUTH 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	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	295-14-006	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487755922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERCEPT YOUTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	5511 STAPLES MILL RD
Second Line	:	SUITE 102
City	:	RICHMOND
State	:	VA
Zip	:	23228-5445
Country	:	US
Telephone Number	:	804-864-1320
Fax Number	:	804-864-1323

Provider Business Practice Location Address
First Line	:	2241 S PROVIDENCE RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23236-2159
Country	:	US
Telephone Number	:	804-497-7900
Fax Number	:	804-497-7902

Authorized Official
Title or Position	:	REVENUE CYCLE MANAGER
Name	:	YOLANDA WINFIELD
Credential	:
Telephone Number	:	804-807-1201

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	11/19/2024

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Directions to “INTERCEPT YOUTH SERVICES, INC. ” Practice Location

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