POLK YOUTH SERVICES, INC. (NPI# 1427414895) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427414895 |
| Entity Type | Organization |
| Organization Name | POLK YOUTH SERVICES, INC. |
| Practice Address |
175 Ne Kings Valley Hwy Ste A Dallas OR 97338-1787 |
| Practice Telephone | 5036233310 |
| Mailing Telephone | 5036233310 |
| Enumeration Date | 2016-01-14 |
| Last Update Date | 2016-01-14 |
| Authorized Official Name | DAVID JAMES VALENCIA (EXECUTIVE DIRECTOR/PRESIDENT) |
| Authorized Official Telephone | 5036233310 |
| Authorized Official Credential | MS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | 0243 | OR | Residential Treatment Facilities |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | POLK YOUTH SERVICES, INC. | 16140 Ellendale Rd, Dallas, OR 97338 |
| Street Address |
175 NE KINGS VALLEY HWY STE A |
| City | DALLAS |
| State | OR |
| Zip Code | 97338-1787 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164932042 | Stephanie Marie Renfro | Massage Therapist | 289 E Ellendale Ave #601, Dallas, OR 97338 | 2017-10-05 |
| 1588185953 | Herbert Starr Woodward IIi | Dentist | 201 Se Washington St, Dallas, OR 97338 | 2017-07-06 |
| 1851708077 | David Mooso | Pharmacist | 321 Nw Kings Valley Highway, Dallas, OR 97338 | 2014-07-21 |
| 1841615556 | Leslie Lytle | Counselor | 1020 Sw Maple St., Dallas, OR 97338 | 2014-03-04 |
| 1205265493 | Chung-fan Ni | Counselor | 182 S. W. Academy St., Academy Building, Dallas, OR 97338 | 2013-11-07 |
| 1215204300 | Ron Fritz | Counselor | 239 E. Ellendale, Suite 602, Dallas, OR 97338 | 2011-11-17 |
| 1235420167 | Deborah Kennedy | Counselor | 527 Ne Fern Ave, Dallas, OR 97338 | 2011-04-26 |
| 1821229774 | Chelsea Ruhoff Lee | Physician Assistant | 1000 Se Uglow Avenue, Flaming Medical Center, Dallas, OR 97338 | 2009-07-27 |
| 1013128560 | Larry J Vuylsteke | Social Worker | 182 S.w. Academy, Dallas, OR 97338 | 2007-05-25 |
| 1093926123 | Justin W Reed | Counselor | Academy Building, 182 S.w. Academy St. Suite 304, Dallas, OR 97338 | 2007-05-24 |
| Find all providers in zip 97338 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376883322 | Angels With Open Arms | Residential Treatment Facility, Emotionally Disturbed Children | 6435 Tumbling Creek Trl, Dallas, TX 75241-5915 | 2013-02-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811541568 | Dragonfly Programs, LLC | Residential Treatment Facility, Emotionally Disturbed Children | 505 N 9th St, Klamath Falls, OR 97601-2876 | 2019-07-31 |
| 1740844984 | Brigacare, Incorporated | Residential Treatment Facility, Emotionally Disturbed Children | 15703 Sw Whetstone Way, Sherwood, OR 97140-8895 | 2019-04-23 |
| 1275085128 | Northwest Youth Discovery | Residential Treatment Facility, Emotionally Disturbed Children | 61850 Dobbin Rd, Bend, OR 97702-9536 | 2016-10-26 |
| 1083070361 | Oregon 180 | Residential Treatment Facility, Emotionally Disturbed Children | 725 W 14th St, Medford, OR 97501-3429 | 2016-01-03 |
| 1013395953 | Bridges Academy Corp | Residential Treatment Facility, Emotionally Disturbed Children | 67030 Gist Rd, Bend, OR 97701-9209 | 2015-05-12 |
| 1336565993 | Northwest Youth Discovery | Residential Treatment Facility, Emotionally Disturbed Children | 9 Nw 15th St, Bend, OR 97701-3102 | 2014-03-06 |
| 1528499696 | Klamath Lake County Youth Ranch | Residential Treatment Facility, Emotionally Disturbed Children | 5800 Happy Hollow Ln, Bonanza, OR 97623-7714 | 2013-11-27 |
| 1487082681 | Yamhill County Juvenile Department | Residential Treatment Facility, Emotionally Disturbed Children | 535 E 5th St, Mcminnville, OR 97128-4504 | 2013-10-24 |
| 1154758266 | Youth Guidance Association | Residential Treatment Facility, Emotionally Disturbed Children | 2730 Ne Flanders St, Portland, OR 97232-3160 | 2013-10-03 |
| 1306288071 | The Inn, Home for Boys | Residential Treatment Facility, Emotionally Disturbed Children | 8940 Se 72nd Ave, Portland, OR 97206-9417 | 2013-07-23 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.