Basic Information
| Provider Information | |||||||||
| NPI: | 1194137232 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | YOUTH HAVEN SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 229 TURNER DR | ||||||||
| Address2: | |||||||||
| City: | REIDSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273205736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3363492233 | ||||||||
| FaxNumber: | 3366340444 | ||||||||
| Practice Location | |||||||||
| Address1: | 1112 BARNES ST | ||||||||
| Address2: | |||||||||
| City: | REIDSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273204975 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3363477375 | ||||||||
| FaxNumber: | 3366340444 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2014 | ||||||||
| LastUpdateDate: | 10/21/2020 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | DAWN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO/CLINICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3366349039 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
| NPICertificationDate: | 10/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 322D00000X | Y | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children |
No ID Information.