Provider Demographics
NPI:1578074142
Name:RESTORED YOUTH SERVICES, LLC
Entity Type:Organization
Organization Name:RESTORED YOUTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:RUNETTA
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:336-302-9451
Mailing Address - Street 1:4223 BENTLEY DR
Mailing Address - Street 2:
Mailing Address - City:RANDLEMAN
Mailing Address - State:NC
Mailing Address - Zip Code:27317-8306
Mailing Address - Country:US
Mailing Address - Phone:336-302-9451
Mailing Address - Fax:
Practice Address - Street 1:305 D ST
Practice Address - Street 2:
Practice Address - City:N WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-4345
Practice Address - Country:US
Practice Address - Phone:335-990-0688
Practice Address - Fax:336-990-0687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness