Provider Demographics
NPI:1417514753
Name:INTERCEPT YOUTH SERVICES, INC.
Entity Type:Organization
Organization Name:INTERCEPT YOUTH SERVICES, INC.
Other - Org Name:INTERCEPT HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-675-6042
Mailing Address - Street 1:5511 STAPLES MILL RD STE 102
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228-5445
Mailing Address - Country:US
Mailing Address - Phone:804-440-3700
Mailing Address - Fax:804-422-0840
Practice Address - Street 1:201 N MAIN ST STE 1101
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-1300
Practice Address - Country:US
Practice Address - Phone:044-403-7008
Practice Address - Fax:804-422-0840
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTERCEPT YOUTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-22
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency