Provider Demographics
NPI:1033128616
Name:YOUTH VILLAGE OF VOLUSIA COUNTY INC
Entity Type:Organization
Organization Name:YOUTH VILLAGE OF VOLUSIA COUNTY INC
Other - Org Name:'OUR' CHILDREN FIRST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:
Authorized Official - Last Name:MOCCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-248-2771
Mailing Address - Street 1:517 S RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-4929
Mailing Address - Country:US
Mailing Address - Phone:386-248-2771
Mailing Address - Fax:386-248-2874
Practice Address - Street 1:517 S RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-4929
Practice Address - Country:US
Practice Address - Phone:386-248-2771
Practice Address - Fax:386-248-2874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL752892200Medicaid
FL752892201Medicaid
FL761652000Medicaid