Provider Demographics
NPI:1952582751
Name:CHESTERFIELD YOUTH GROUP HOME
Entity Type:Organization
Organization Name:CHESTERFIELD YOUTH GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:S
Authorized Official - Last Name:DUGGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1804-748-1857
Mailing Address - Street 1:9610 KRAUSE RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-6717
Mailing Address - Country:US
Mailing Address - Phone:180-474-8161
Mailing Address - Fax:180-474-8129
Practice Address - Street 1:9610 KRAUSE RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-6717
Practice Address - Country:US
Practice Address - Phone:180-474-8161
Practice Address - Fax:180-474-8129
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHESTERFIELD COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness