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NPI Code Detail

MEDICARE: YOUTH DIMENSIONS, INC

MEDICARE: YOUTH DIMENSIONS, 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
1320600000XIntellectual and/or Developmental Disabilities Residential Treatment FacilityL2370486769TN

General Provider Information

NPI Number : 1811146269
Entity Type Code : Organization
Provider Name (Legal Business Name) : YOUTH DIMENSIONS, INC
Provider Business Mailing Address
First Line : 3385 AUSTIN PEAY HWY
Second Line :
City : MEMPHIS
State : TN
Zip : 38128-3810
Country : US
Telephone Number : 901-213-9000
Fax Number : 901-213-9771
Provider Business Practice Location Address
First Line : 3385 AUSTIN PEAY HWY
Second Line :
City : MEMPHIS
State : TN
Zip : 38128-3810
Country : US
Telephone Number : 901-213-9000
Fax Number : 901-213-9771
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. RODERICK E SCOTT
Credential :
Telephone Number : 901-213-9000
Provider Enumeration Date : 09/10/2008
Last Update Date : 09/10/2008

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Directions to “YOUTH DIMENSIONS, INC ” Practice Location

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