Provider Demographics
NPI:1265981310
Name:CHAPARRAL YOUTH SERVICES II
Entity type:Organization
Organization Name:CHAPARRAL YOUTH SERVICES II
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHEREE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-827-1169
Mailing Address - Street 1:68 THREE HUNTS DR STE B
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-7319
Mailing Address - Country:US
Mailing Address - Phone:910-827-1169
Mailing Address - Fax:
Practice Address - Street 1:68 THREE HUNTS DR STE B
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-7319
Practice Address - Country:US
Practice Address - Phone:910-827-1169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3855251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health