Provider Demographics
NPI:1811038995
Name:CATAWBA YOUTH SERVICES, INC.
Entity Type:Organization
Organization Name:CATAWBA YOUTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:EVANS
Authorized Official - Last Name:LINEBARGER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW,ACSW,LCSW
Authorized Official - Phone:828-324-5463
Mailing Address - Street 1:PO BOX 2681
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28603-2681
Mailing Address - Country:US
Mailing Address - Phone:828-324-5463
Mailing Address - Fax:828-324-7354
Practice Address - Street 1:1822 KINCAID CT
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-5546
Practice Address - Country:US
Practice Address - Phone:828-294-0731
Practice Address - Fax:828-324-7354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL018066322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603310Medicaid