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Organization

INTERCEPT YOUTH SERVICES, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DON KAMENCIK (CFO)
(804) 864-1320
Entity
Organization

Contact information

Practice address
3400 NEWBYS BRIDGE RD, CHESTERFIELD, VA 23832-7828
(804) 726-8690
(804) 726-8692
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
295-14-010
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
010090415
VA
Enumeration date
09/26/2006
Last updated
09/24/2020
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