Provider Demographics
NPI:1164740734
Name:YOUTH SERVICE INTERNATIONAL INC.
Entity Type:Organization
Organization Name:YOUTH SERVICE INTERNATIONAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SLATTERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1800-275-3766
Mailing Address - Street 1:6000 CATTLERIDGE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6064
Mailing Address - Country:US
Mailing Address - Phone:800-275-3766
Mailing Address - Fax:
Practice Address - Street 1:709 6TH STREET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:SD
Practice Address - Zip Code:57062
Practice Address - Country:US
Practice Address - Phone:605-369-2585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2385323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility