Basic Information
| Provider Information | |||||||||
| NPI: | 1477150910 | ||||||||
| EntityType: | 2 | ||||||||
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| 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: | 730 SPRING DRIVE | ||||||||
| Address2: | |||||||||
| City: | TOQUERVILLE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84774 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356350300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2020 | ||||||||
| LastUpdateDate: | 12/08/2020 | ||||||||
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| AuthorizedOfficialLastName: | TURNER | ||||||||
| AuthorizedOfficialFirstName: | KAY | ||||||||
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| AuthorizedOfficialTitleorPosition: | ACCOUNT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2568803339 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320800000X | N | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | 324500000X | N | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | 323P00000X | Y | Residential Treatment Facilities | Psychiatric Residential Treatment Facility |
ID Information
| ID | Type | State | Issuer | Description | 607155 | 05 | MT | MEDICAID |