Provider Demographics
NPI:1659931087
Name:INTERCEPT YOUTH SERVICES, INC.
Entity Type:Organization
Organization Name:INTERCEPT YOUTH SERVICES, INC.
Other - Org Name:INTERCEPT HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:046-756-0428
Mailing Address - Street 1:5511 STAPLES MILL RD STE 102
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228-5445
Mailing Address - Country:US
Mailing Address - Phone:804-440-3700
Mailing Address - Fax:804-422-0840
Practice Address - Street 1:625 PINEY FOREST RD STE 105
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-2868
Practice Address - Country:US
Practice Address - Phone:804-440-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTERCEPT YOUTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-18
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency