Provider Demographics
NPI:1841429933
Name:AT&B RESIDENTIAL YOUTH GROUP SERVICES
Entity Type:Organization
Organization Name:AT&B RESIDENTIAL YOUTH GROUP SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMIE
Authorized Official - Middle Name:DELAINE
Authorized Official - Last Name:NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-684-5079
Mailing Address - Street 1:P.O. BOX 2274
Mailing Address - Street 2:215 W. RUFFIN ST.
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27216-2274
Mailing Address - Country:US
Mailing Address - Phone:336-684-5079
Mailing Address - Fax:
Practice Address - Street 1:215 W. RUFFIN ST.
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27216-2274
Practice Address - Country:US
Practice Address - Phone:336-228-8837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AT&B RESIDENTIAL YOUTH GROUP SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness