Lake House

LBN: Intercept Youth Services, Inc.
Lake House is an health care organization with primary practice located at 5500 Staples Mill Rd , Richmond VA 23228-5423. 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) 264-2954, or through Graham, David Randolph via phone (804) 864-1320.

Contact Information

Primary practice address
5500 Staples Mill Rd Richmond VA 23228-5423
Phone: (804) 264-2954
Fax: (804) 264-1893
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 295-14-002 Virginia

Profile Details

NPI number 1841391372
LBN Legal business name Intercept Youth Services, Inc.
DBA Doing business as Lake 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 1841391372 NPPES
Virginia MEDICAID 010075581

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