Provider Demographics
NPI:1669505483
Name:REYNOLDS YOUTH SERVICES
Entity Type:Organization
Organization Name:REYNOLDS YOUTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:E
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-247-4856
Mailing Address - Street 1:2020 US HIGHWAY 221 S
Mailing Address - Street 2:
Mailing Address - City:FOREST CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28043-7056
Mailing Address - Country:US
Mailing Address - Phone:828-247-4856
Mailing Address - Fax:828-247-4857
Practice Address - Street 1:2020 US HIGHWAY 221 S
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-7056
Practice Address - Country:US
Practice Address - Phone:828-247-4856
Practice Address - Fax:828-247-4857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL 081-066322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603988Medicaid