Provider Demographics
NPI:1497956270
Name:YOUTH VILLAGES
Entity Type:Organization
Organization Name:YOUTH VILLAGES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPEUTIC FOSTER CARE
Authorized Official - Prefix:
Authorized Official - First Name:LEANNA
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:BROTHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:256-774-8359
Mailing Address - Street 1:9238 MADISON BLVD BLDG 1
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-9100
Mailing Address - Country:US
Mailing Address - Phone:256-774-8359
Mailing Address - Fax:
Practice Address - Street 1:9238 MADISON BLVD BLDG 1
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-9100
Practice Address - Country:US
Practice Address - Phone:256-774-8359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health