Provider Demographics
NPI:1821609942
Name:OPTIMUM YOUTH SERVICES LLC
Entity Type:Organization
Organization Name:OPTIMUM YOUTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRATHWAITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-525-8069
Mailing Address - Street 1:10524 BRIGHTSTONE DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-1570
Mailing Address - Country:US
Mailing Address - Phone:804-986-8392
Mailing Address - Fax:
Practice Address - Street 1:725 S PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-3337
Practice Address - Country:US
Practice Address - Phone:804-525-4069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children