Provider Demographics
NPI:1104066638
Name:YOUTH ENVIRONMENTAL SERVICES
Entity type:Organization
Organization Name:YOUTH ENVIRONMENTAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-671-5213
Mailing Address - Street 1:4337 SAFFOLRD RD
Mailing Address - Street 2:
Mailing Address - City:WIMAUMA
Mailing Address - State:FL
Mailing Address - Zip Code:33598-4419
Mailing Address - Country:US
Mailing Address - Phone:813-671-5213
Mailing Address - Fax:813-671-5216
Practice Address - Street 1:4337 SAFFOLD RD
Practice Address - Street 2:
Practice Address - City:WIMAUMA
Practice Address - State:FL
Practice Address - Zip Code:33598-4419
Practice Address - Country:US
Practice Address - Phone:813-671-5213
Practice Address - Fax:813-671-5216
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASSOCIATED MARINE INSTITUTES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness