Provider Demographics
NPI:1457562902
Name:YOUTHVILLE
Entity Type:Organization
Organization Name:YOUTHVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST-COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:B
Authorized Official - Last Name:SUMAYA
Authorized Official - Suffix:
Authorized Official - Credentials:MASTERS DEGREE
Authorized Official - Phone:620-225-0276
Mailing Address - Street 1:900 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-2037
Mailing Address - Country:US
Mailing Address - Phone:316-283-1950
Mailing Address - Fax:316-283-9540
Practice Address - Street 1:11200 LARIAT WAY
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-7328
Practice Address - Country:US
Practice Address - Phone:620-225-0276
Practice Address - Fax:620-225-1854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS850323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility