Provider Demographics
NPI:1154448496
Name:YOUTH DIVERSITY COALITION, L.L.C.
Entity Type:Organization
Organization Name:YOUTH DIVERSITY COALITION, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.A.O
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-228-3729
Mailing Address - Street 1:8025 HILLCREEK DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-6847
Mailing Address - Country:US
Mailing Address - Phone:804-833-6053
Mailing Address - Fax:804-639-6933
Practice Address - Street 1:2916 VALLEY SIDE TER
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-1163
Practice Address - Country:US
Practice Address - Phone:804-228-3729
Practice Address - Fax:804-228-1843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAS8-04-20320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities