MEDICARE: YOUTH VILLAGES

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	251S00000X	Community/Behavioral Health Agency	BLC10015648503	VA

General Provider Information

NPI Number	:	1922470210
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUTH VILLAGES

Provider Business Mailing Address
First Line	:	1911 N FORT MYER DRIVE
Second Line	:	305
City	:	ARLINGTON
State	:	VA
Zip	:	22209
Country	:	US
Telephone Number	:	703-516-6951
Fax Number	:

Provider Business Practice Location Address
First Line	:	1911 FORT MYER DR
Second Line	:	305
City	:	ARLINGTON
State	:	VA
Zip	:	22209-1607
Country	:	US
Telephone Number	:	703-516-6951
Fax Number	:

Authorized Official
Title or Position	:	DISTRICT MANAGER
Name	:	AUSTIN HICKS
Credential	:
Telephone Number	:	703-516-6951

Provider Enumeration Date	:	10/26/2015
Last Update Date	:	10/26/2015

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Directions to “YOUTH VILLAGES ” Practice Location

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