Provider Demographics
NPI:1497825723
Name:THE YOUTH ACADEMY INC
Entity Type:Organization
Organization Name:THE YOUTH ACADEMY INC
Other - Org Name:YOUTH ACADEMY GROUP HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD
Authorized Official - Prefix:
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BOSTON
Authorized Official - Suffix:SR
Authorized Official - Credentials:PASTOR
Authorized Official - Phone:843-382-5927
Mailing Address - Street 1:POST OFFICE BOX 174
Mailing Address - Street 2:
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556
Mailing Address - Country:US
Mailing Address - Phone:843-382-5927
Mailing Address - Fax:843-382-5826
Practice Address - Street 1:237 LELA HARRISON ROAD
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556
Practice Address - Country:US
Practice Address - Phone:843-382-5927
Practice Address - Fax:843-382-5826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC944MXHMedicaid