Provider Demographics
NPI:1003031436
Name:FAMILIES & YOUTH, INC
Entity Type:Organization
Organization Name:FAMILIES & YOUTH, INC
Other - Org Name:FYI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAVANAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:575-644-0485
Mailing Address - Street 1:PO BOX 1868
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88004-1868
Mailing Address - Country:US
Mailing Address - Phone:505-522-4004
Mailing Address - Fax:505-522-9017
Practice Address - Street 1:1320 S. SOLANO DRIVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-3758
Practice Address - Country:US
Practice Address - Phone:505-522-4004
Practice Address - Fax:505-522-9017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
NM1077A322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMB9814Medicaid
NMM1497Medicaid
NMM0161Medicaid