Organization
INTERCEPT YOUTH SERVICES, INC.
Active
Other names
Spring House
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID RANDOLPH GRAHAM (DIR OF ACCOUNTING & ADMINISTRATION)
(804) 864-1320
Entity
Organization
Contact information
Practice address
2129 S PROVIDENCE RD, RICHMOND, VA 23236-2160
(804) 249-3350
(804) 249-3352
Mailing address
5511 STAPLES MILL RD, SUITE 102, RICHMOND, VA 23228-5445
(804) 864-1320
(804) 864-1323
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
295-14-011
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010122198
—
VA
Enumeration date
09/26/2006
Last updated
09/24/2020
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