Provider Demographics
NPI:1902860182
Name:G4S YOUTH SERVICES, LLC
Entity Type:Organization
Organization Name:G4S YOUTH SERVICES, LLC
Other - Org Name:SECURICOR NEW CENTURY, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:Y
Authorized Official - Last Name:BROWNE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:804-754-1100
Mailing Address - Street 1:9609 GAYTON RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-4900
Mailing Address - Country:US
Mailing Address - Phone:804-754-1100
Mailing Address - Fax:804-741-9515
Practice Address - Street 1:765 E SAINT JOHNS AVE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:FL
Practice Address - Zip Code:32145-3936
Practice Address - Country:US
Practice Address - Phone:904-692-2920
Practice Address - Fax:904-692-3611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0707546 00Medicaid