Provider Demographics
NPI:1235430570
Name:RESIDENTIAL YOUTH SERVICES, INC.
Entity Type:Organization
Organization Name:RESIDENTIAL YOUTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:MANNING
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:703-841-7768
Mailing Address - Street 1:14160 NEWBROOK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-2297
Mailing Address - Country:US
Mailing Address - Phone:703-841-7768
Mailing Address - Fax:703-842-2341
Practice Address - Street 1:4820 WELFORD ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22309-1044
Practice Address - Country:US
Practice Address - Phone:703-347-6423
Practice Address - Fax:703-347-6424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA292-14-002322D00000X
VA292-14-007322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children