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NPI Code Detail

MEDICARE: INTERCEPT YOUTH SERVICES, INC.

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
1322D00000XEmotionally Disturbed Childrens' Residential Treatment Facility295-14-006VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID 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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