Provider Demographics
NPI:1326145525
Name:YOUTH HEALTH SERVICE, INC
Entity Type:Organization
Organization Name:YOUTH HEALTH SERVICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARBOGAST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-636-2282
Mailing Address - Street 1:971 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241
Mailing Address - Country:US
Mailing Address - Phone:304-636-9450
Mailing Address - Fax:304-636-2282
Practice Address - Street 1:971 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241
Practice Address - Country:US
Practice Address - Phone:304-636-9450
Practice Address - Fax:304-636-2282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV55251B00000X
55251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001710052OtherBLUE CROSS & BLUE SHIELD
WV0023397001Medicaid
WV001710053OtherBCBS CHANDRAN
WV001855121OtherMT STATE BCBS (LPC)
WV0023397000Medicaid