Providence House

LBN: Intercept Youth Services, Inc.
Providence House is an health care organization with primary practice located at 2241 S Providence Rd , Richmond VA 23236-2159. The organization recently has only one registered license in Residential Treatment Facilities / Residential Treatment Facility, Emotionally Disturbed Children, which is considered as the primary health care specialty. Intercept Youth Services, Inc. can be contacted via phone (804) 497-7900, or through Graham, David Randolph via phone (804) 864-1320.

Contact Information

Primary practice address
2241 S Providence Rd Richmond VA 23236-2159
Phone: (804) 497-7900
Fax: (804) 497-7902
Website:
Map and Directions
Authorized official contact:
Name: Graham, David Randolph
Phone: (804) 864-1320

Health care specialties

SpecialtyCodeLicense #State
Residential Treatment Facilities / Residential Treatment Facility, Emotionally Disturbed Children 322D00000X 295-14-006 Virginia

Profile Details

NPI number 1487755922
LBN Legal business name Intercept Youth Services, Inc.
DBA Doing business as Providence House
Authorized official Graham, David Randolph
Entity Organization
Organization subpart 1 No
Enumeration date Sep 26th, 2006
Last updated Sep 24th, 2020 - about 4 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1487755922 NPPES
Virginia MEDICAID 010075645

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