# SANTA ROSA YOUTH ACADEMY

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** YOUTH SERVICES INTERNATIONAL, INC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1568678514
- **Legal business name:** YOUTH SERVICES INTERNATIONAL, INC
- **Authorized official:** MS. MICHELLE MOODY L.C.S.W. (CLINICAL DIRECTOR)
- **Authorized official phone:** (850) 957-3600

## Contact information

- **Practice address:** 12364 ENVIRONMENTAL CENTER RD, HOLT, FL 32564-9126
- **Practice address phone:** (850) 957-3600
- **Practice address fax:** (850) 957-9000
- **Mailing address:** 12364 ENVIRONMENTAL CENTER RD, HOLT, FL 32564-9126
- **Mailing address phone:** (850) 957-3600
- **Mailing address fax:** (850) 957-9000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | — | NULL | Yes |
| 3245S0500X | Children's Substance Abuse Rehabilitation Facility | 0157AD569002 | FL | — |

## Other

- **Enumeration date:** 05/15/2007
- **Last updated:** 07/14/2009