Organization
YOUTH HAVEN SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DAWN TUCKER JOHNSON LCSW (PRESIDENT)
(336) 349-2233
Entity
Organization
Contact information
Practice address
1115 ROSEMONT DR, REIDSVILLE, NC 27320-4405
(336) 349-2233
(336) 634-0444
Mailing address
229 TURNER DR, REIDSVILLE, NC 27320-5736
(336) 349-2233
(336) 634-0444
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
MHL079073
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6604091
—
NC
Enumeration date
04/19/2007
Last updated
10/21/2020
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