Provider Demographics
NPI:1023187200
Name:PROFESSIONAL YOUTH SERVICES
Entity Type:Organization
Organization Name:PROFESSIONAL YOUTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEMARN
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:THORPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-674-4460
Mailing Address - Street 1:7206 HULL STREET RD
Mailing Address - Street 2:SUITE 102A
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-5827
Mailing Address - Country:US
Mailing Address - Phone:804-674-4460
Mailing Address - Fax:804-674-4480
Practice Address - Street 1:4136 WOODFIELD RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23234-3450
Practice Address - Country:US
Practice Address - Phone:804-674-4456
Practice Address - Fax:804-674-4458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness