Organization
INTERCEPT YOUTH SERVICES, INC.
Active
Other names
Providence House
Organization subpart
No
Provider details
NPI number
Authorized official
YOLANDA WINFIELD (REVENUE CYCLE MANAGER)
(804) 807-1201
Entity
Organization
Contact information
Practice address
2241 S PROVIDENCE RD, RICHMOND, VA 23236-2159
(804) 497-7900
(804) 497-7902
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
295-14-006
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30015173320394
—
VA
Enumeration date
09/26/2006
Last updated
11/19/2024
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