Provider Demographics
NPI:1609926575
Name:IMPACT YOUTH AND FAMILY SERVICES, INC.
Entity Type:Organization
Organization Name:IMPACT YOUTH AND FAMILY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-639-3625
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRING
Mailing Address - State:NC
Mailing Address - Zip Code:27592-0157
Mailing Address - Country:US
Mailing Address - Phone:919-639-3625
Mailing Address - Fax:888-470-3543
Practice Address - Street 1:109 DEER FARM LN
Practice Address - Street 2:
Practice Address - City:WILLOW SPRING
Practice Address - State:NC
Practice Address - Zip Code:27592-8505
Practice Address - Country:US
Practice Address - Phone:919-639-3625
Practice Address - Fax:888-470-3543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-051-146320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities