# BRISTOL YOUTH ACADEMY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447359435
- **Authorized official:** JEANETTE JACKSON (ADMIN)
- **Authorized official phone:** (850) 643-4600

## Contact information

- **Practice address:** 12422 NW GORDON TRUETT REVELL RD, BRISTOL, FL 32321-3007
- **Practice address phone:** (850) 643-4600
- **Practice address fax:** (850) 643-2061
- **Mailing address:** 12422 NW GORDON TRUETT REVELL RD, BRISTOL, FL 32321-3007
- **Mailing address phone:** (850) 643-4600
- **Mailing address fax:** (850) 643-2061

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 323P00000X | Psychiatric Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 09/22/2006
- **Last updated:** 07/21/2022