Provider Demographics
NPI:1790147288
Name:YOUTH VILLAGES
Entity Type:Organization
Organization Name:YOUTH VILLAGES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRANSITIONAL LIVING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CHANTAE
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-624-7387
Mailing Address - Street 1:4 MITCHELL WOOTEN CT
Mailing Address - Street 2:H
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-4654
Mailing Address - Country:US
Mailing Address - Phone:252-624-7387
Mailing Address - Fax:
Practice Address - Street 1:2313 EXECUTIVE CIR
Practice Address - Street 2:SUITE C
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3744
Practice Address - Country:US
Practice Address - Phone:252-215-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health