Provider Demographics
NPI:1376763961
Name:YOUTH VILLAGES
Entity Type:Organization
Organization Name:YOUTH VILLAGES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PLACEMENT COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:PETTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-288-4623
Mailing Address - Street 1:47 KEY CORNER RD
Mailing Address - Street 2:
Mailing Address - City:HALLS
Mailing Address - State:TN
Mailing Address - Zip Code:38040
Mailing Address - Country:US
Mailing Address - Phone:731-288-4623
Mailing Address - Fax:731-288-4650
Practice Address - Street 1:47 KEY CORNER RD
Practice Address - Street 2:
Practice Address - City:HALLS
Practice Address - State:TN
Practice Address - Zip Code:38040-5051
Practice Address - Country:US
Practice Address - Phone:731-288-4623
Practice Address - Fax:731-288-4650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health