Provider Demographics
NPI:1184950412
Name:JOHNNY'S HEROES YOUTH & FAMILY SERVICES, INC.
Entity type:Organization
Organization Name:JOHNNY'S HEROES YOUTH & FAMILY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:804-370-9963
Mailing Address - Street 1:P O BOX 5549
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-0549
Mailing Address - Country:US
Mailing Address - Phone:804-782-2255
Mailing Address - Fax:804-782-0186
Practice Address - Street 1:502 FRANKLIN STREET
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-1526
Practice Address - Country:US
Practice Address - Phone:434-792-9070
Practice Address - Fax:434-792-9071
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHNNY'S HEROES YOUTH & FAMILY SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
662-02-029251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health