Basic Information
| Provider Information | |||||||||
| NPI: | 1295188209 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CARE YOUTH CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1131 EAGLETREE LN SW | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358016491 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568803339 | ||||||||
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| Practice Location | |||||||||
| Address1: | 750 E SR 9 | ||||||||
| Address2: | |||||||||
| City: | VIRGIN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 847797726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356355260 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2016 | ||||||||
| LastUpdateDate: | 02/15/2021 | ||||||||
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| AuthorizedOfficialLastName: | BERNARD | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF PROGRAM OFFICER/EVP | ||||||||
| AuthorizedOfficialTelephone: | 8017072450 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | 02/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320800000X | N | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | 323P00000X | Y | Residential Treatment Facilities | Psychiatric Residential Treatment Facility |
No ID Information.