Provider Demographics
NPI:1710907597
Name:INTEGRATED YOUTH SERVICES INC
Entity Type:Organization
Organization Name:INTEGRATED YOUTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:NUSCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-427-3837
Mailing Address - Street 1:1321 RESEARCH PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45432
Mailing Address - Country:US
Mailing Address - Phone:937-427-3837
Mailing Address - Fax:937-427-4516
Practice Address - Street 1:1321 RESEARCH PARK DRIVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45432
Practice Address - Country:US
Practice Address - Phone:937-427-3837
Practice Address - Fax:937-427-4516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH493261QM0855X
OH11001261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Not Answered261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2369119Medicaid
11001Medicare UPIN