Provider Demographics
NPI:1376728949
Name:DIAMONDS IN THE ROUGH YOUTH AND FAMILY SERVICES, INC.
Entity Type:Organization
Organization Name:DIAMONDS IN THE ROUGH YOUTH AND FAMILY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-213-0140
Mailing Address - Street 1:P O BOX 6386
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3531
Mailing Address - Country:US
Mailing Address - Phone:804-213-0140
Mailing Address - Fax:804-213-0143
Practice Address - Street 1:4901 FITZHUGH AVE., STE. 200
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3531
Practice Address - Country:US
Practice Address - Phone:804-213-0140
Practice Address - Fax:804-213-0143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA464-05-001251S00000X
VA464-14-001320600000X, 322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children