Provider Demographics
NPI:1326186347
Name:DIAMOND STATE YOUTH, INC.
Entity Type:Organization
Organization Name:DIAMOND STATE YOUTH, INC.
Other - Org Name:DIAMOND STATE YOUTH BEHAVIORAL HEALTH SYSTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:E
Authorized Official - Last Name:SARGEANT
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:302-762-6360
Mailing Address - Street 1:1413 LORE AVENUE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19809
Mailing Address - Country:US
Mailing Address - Phone:302-762-6360
Mailing Address - Fax:302-762-6362
Practice Address - Street 1:1413 LORE AVENUE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19809
Practice Address - Country:US
Practice Address - Phone:302-762-6360
Practice Address - Fax:302-762-6362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE29182320600000X, 320800000X, 322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness