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
2419 FON DU LAC RD, RICHMOND, VA 23229
(804) 440-7074
(804) 440-7075
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
406-14-001
VA
Other
Enumeration date
01/30/2007
Last updated
08/22/2020
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