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NPI Code Detail

MEDICARE: INTEGRATED YOUTH SERVICES, INC.

MEDICARE: INTEGRATED 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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)10009282SUPVOH

General Provider Information

NPI Number : 1518138031
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTEGRATED YOUTH SERVICES, INC.
Provider Business Mailing Address
First Line : 1321 RESEARCH PARK DR
Second Line :
City : BEAVERCREEK
State : OH
Zip : 45432-2851
Country : US
Telephone Number : 937-427-3837
Fax Number : 937-427-4516
Provider Business Practice Location Address
First Line : 1321 RESEARCH PARK DR
Second Line :
City : BEAVERCREEK
State : OH
Zip : 45432-2851
Country : US
Telephone Number : 937-427-3837
Fax Number : 937-427-4516
Authorized Official
Title or Position : CEO
Name : MR. DAVID D. NUSCHER
Credential :
Telephone Number : 937-427-3837
Provider Enumeration Date : 03/13/2008
Last Update Date : 03/13/2008

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