Provider Demographics
NPI:1760576797
Name:ETOWAH YOUTH SERVICES INC.
Entity Type:Organization
Organization Name:ETOWAH YOUTH SERVICES INC.
Other - Org Name:EAGLE ROCK BOYS RANCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HILTON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:256-538-1687
Mailing Address - Street 1:832 BURGESS RD
Mailing Address - Street 2:
Mailing Address - City:ATTALLA
Mailing Address - State:AL
Mailing Address - Zip Code:35954-5119
Mailing Address - Country:US
Mailing Address - Phone:256-538-1687
Mailing Address - Fax:256-538-0646
Practice Address - Street 1:832 BURGESS RD
Practice Address - Street 2:
Practice Address - City:ATTALLA
Practice Address - State:AL
Practice Address - Zip Code:35954-5119
Practice Address - Country:US
Practice Address - Phone:256-538-1687
Practice Address - Fax:256-538-0646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children