Provider Demographics
NPI:1942509328
Name:PHOENIX YOUTH SERVICES, INC.
Entity Type:Organization
Organization Name:PHOENIX YOUTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/AED
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEMBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-699-3002
Mailing Address - Street 1:797 HARTFORD RD
Mailing Address - Street 2:
Mailing Address - City:SHARPSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16150-9650
Mailing Address - Country:US
Mailing Address - Phone:724-646-1717
Mailing Address - Fax:724-646-1770
Practice Address - Street 1:556 CONNEAUT LAKE ROAD
Practice Address - Street 2:
Practice Address - City:ADAMSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16110
Practice Address - Country:US
Practice Address - Phone:724-588-3425
Practice Address - Fax:724-588-3811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children