Provider Demographics
NPI:1366799561
Name:YOUTH HEALTH SERVICE INC
Entity type:Organization
Organization Name:YOUTH HEALTH SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:KOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-636-9450
Mailing Address - Street 1:971 HARRISON AVENUE
Mailing Address - Street 2:YOUTH HEALTH SERVICE INC
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241
Mailing Address - Country:US
Mailing Address - Phone:304-636-9450
Mailing Address - Fax:304-636-2282
Practice Address - Street 1:971 HARRISON AVENUE
Practice Address - Street 2:YOUTH HEALTH SERVICE INC
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241
Practice Address - Country:US
Practice Address - Phone:304-636-9450
Practice Address - Fax:304-636-2282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP00944009104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0023397001Medicaid