Organization
DOMINION YOUTH SERVICES
Active
Other names
Dominion Youth Services Residential
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
4802 NORTHRIDGE LANE, ROANOKE, VA 24019
(540) 366-3080
(540) 366-3081
Mailing address
8401 MAYLAND DRIVE, SUITE C, RICHMOND, VA 23294
(804) 285-9838
(804) 285-9839
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
40614077
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
406-14-077
DMH LICENSE
VA
Enumeration date
06/23/2008
Last updated
06/23/2008
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