Provider Demographics
NPI:1326498171
Name:YOUTH VILLAGES
Entity Type:Organization
Organization Name:YOUTH VILLAGES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOLLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-516-6349
Mailing Address - Street 1:2659 SW 4TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-6406
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2659 SW 4TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-6406
Practice Address - Country:US
Practice Address - Phone:541-516-6349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management