Provider Demographics
NPI:1629117262
Name:ALTERNATIVE RESIDENTIAL YOUTH RESOURCES
Entity Type:Organization
Organization Name:ALTERNATIVE RESIDENTIAL YOUTH RESOURCES
Other - Org Name:ACHIEVEMENT PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR, OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:PARRISH
Authorized Official - Suffix:
Authorized Official - Credentials:MSW QMHP
Authorized Official - Phone:336-392-0489
Mailing Address - Street 1:PO BOX 41013
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27404-1013
Mailing Address - Country:US
Mailing Address - Phone:336-392-0489
Mailing Address - Fax:336-294-8432
Practice Address - Street 1:2301 STANLEY RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-3913
Practice Address - Country:US
Practice Address - Phone:336-392-0489
Practice Address - Fax:336-294-8432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-041-670322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603498Medicaid