Provider Demographics
NPI:1538507983
Name:ALC YOUTH & FAMILY SERVICES, LLC
Entity Type:Organization
Organization Name:ALC YOUTH & FAMILY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARQUISE
Authorized Official - Middle Name:LONNELL
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-833-6399
Mailing Address - Street 1:1124 S WEDGEMONT DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-4811
Mailing Address - Country:US
Mailing Address - Phone:804-833-6399
Mailing Address - Fax:
Practice Address - Street 1:14200 KENTWOOD FOREST DR
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-8029
Practice Address - Country:US
Practice Address - Phone:804-454-0125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2248-14-001322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children