Organization
DOMINION YOUTH SERVICES
Active
Other names
Dominion Youth Services Residential LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GL PULLIAM JR. MS (DIRECTOR OF RESIDENTIAL)
(804) 285-9838
Entity
Organization
Contact information
Practice address
2407 DUMBARTON RD, RICHMOND, VA 23228-5909
(804) 553-0595
(804) 553-0596
Mailing address
PO BOX 70296, RICHMOND, VA 23255-0296
(804) 285-9838
(804) 285-9839
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
SS-284-06
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SS-284-06
DSS LICENSE
VA
Enumeration date
03/02/2007
Last updated
08/22/2020
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