Provider Demographics
NPI:1407998883
Name:YOUTH VILLAGES
Entity Type:Organization
Organization Name:YOUTH VILLAGES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR RESIDENTIAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:901-252-7788
Mailing Address - Street 1:7426 MEMPHIS ARLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38135-1908
Mailing Address - Country:US
Mailing Address - Phone:901-252-7788
Mailing Address - Fax:901-252-7990
Practice Address - Street 1:7426 MEMPHIS ARLINGTON RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38135-1908
Practice Address - Country:US
Practice Address - Phone:901-252-7788
Practice Address - Fax:901-252-7990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities