Provider Demographics
NPI:1285838797
Name:PARAMOUNT YOUTH SERVICES
Entity Type:Organization
Organization Name:PARAMOUNT YOUTH SERVICES
Other - Org Name:LAFAYETTE HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:757-623-3184
Mailing Address - Street 1:PO BOX 12152
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23541-0152
Mailing Address - Country:US
Mailing Address - Phone:757-625-0504
Mailing Address - Fax:
Practice Address - Street 1:3115 LORRAINE AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23509-1127
Practice Address - Country:US
Practice Address - Phone:757-625-0504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA37214001320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness