Provider Demographics
NPI:1003005240
Name:PHYD, INC. (PRETTY HOMES YOUTH DEVELOPMENT)
Entity type:Organization
Organization Name:PHYD, INC. (PRETTY HOMES YOUTH DEVELOPMENT)
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRETTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-633-7800
Mailing Address - Street 1:PO BOX 20181
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27619-0181
Mailing Address - Country:US
Mailing Address - Phone:919-633-7800
Mailing Address - Fax:919-713-0034
Practice Address - Street 1:1611 POOLE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-2658
Practice Address - Country:US
Practice Address - Phone:919-713-0035
Practice Address - Fax:919-713-0034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-092-491322D00000X
NCMHL-092-537322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6604280Medicaid
NC6603862Medicaid