Provider Demographics
NPI:1689018426
Name:YOUTH SERVICES INTERNATIONAL
Entity Type:Organization
Organization Name:YOUTH SERVICES INTERNATIONAL
Other - Org Name:ELMORE ACADEMY
Other - Org Type:Other Name
Authorized Official - Title/Position:MENTAL HEALTH CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:507-943-3440
Mailing Address - Street 1:202 E NORTH ST
Mailing Address - Street 2:
Mailing Address - City:ELMORE
Mailing Address - State:MN
Mailing Address - Zip Code:56027-1007
Mailing Address - Country:US
Mailing Address - Phone:507-943-3440
Mailing Address - Fax:507-943-3441
Practice Address - Street 1:202 E NORTH ST
Practice Address - Street 2:
Practice Address - City:ELMORE
Practice Address - State:MN
Practice Address - Zip Code:56027-1007
Practice Address - Country:US
Practice Address - Phone:507-943-3440
Practice Address - Fax:507-943-3441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children