Provider Demographics
NPI:1760543524
Name:VALLEY OF YOUTH
Entity Type:Organization
Organization Name:VALLEY OF YOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECTIVE DIRACTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROLENA
Authorized Official - Middle Name:WILLIAMS
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-836-5849
Mailing Address - Street 1:352 SPRING PARK RD
Mailing Address - Street 2:P.O. BOX 88
Mailing Address - City:MARIETTA
Mailing Address - State:SC
Mailing Address - Zip Code:29661-9229
Mailing Address - Country:US
Mailing Address - Phone:864-836-5849
Mailing Address - Fax:
Practice Address - Street 1:352 SPRING PARK RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:SC
Practice Address - Zip Code:29661-9229
Practice Address - Country:US
Practice Address - Phone:864-836-5849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSR-1002962001-GH320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC891MXHMedicaid