Provider Demographics
NPI:1245426238
Name:YOUTH AND FAMILY RESOURCE SERVICES
Entity Type:Organization
Organization Name:YOUTH AND FAMILY RESOURCE SERVICES
Other - Org Name:FOREST RIDGE YOUTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEVERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-867-4724
Mailing Address - Street 1:4502 230TH ST
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:IA
Mailing Address - Zip Code:51365-7539
Mailing Address - Country:US
Mailing Address - Phone:712-867-4724
Mailing Address - Fax:712-867-4505
Practice Address - Street 1:200 6TH ST
Practice Address - Street 2:
Practice Address - City:GRUVER
Practice Address - State:IA
Practice Address - Zip Code:51334-8518
Practice Address - Country:US
Practice Address - Phone:712-362-5231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children