DOMINION YOUTH SERVICES (NPI# 1952562811) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952562811 |
| Entity Type | Organization |
| Organization Name | DOMINION YOUTH SERVICES |
| Other Organization Name | DOMINION YOUTH SERVICES RESIDENTIAL |
| Practice Address |
4802 Northridge Lane Roanoke VA 24019 |
| Mailing Address |
8401 Mayland Drive Suite C Richmond VA 23294 |
| Practice Telephone | 5403663080 |
| Practice Fax Number | 5403663081 |
| Mailing Telephone | 8042859838 |
| Mailing Fax Number | 8042859839 |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2008-06-23 |
| Authorized Official Name | MR. GL PULLIAM JR. (DIRECTOR OF RESIDENTIAL) |
| Authorized Official Telephone | 8042859838 |
| Authorized Official Credential | MS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | 40614077 | VA | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | DMH LICENSE | 406-14-077 | 01 |
| Other Name | Type Code |
|---|---|
| Dominion Youth Services Residential | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811180458 | Dominion Youth Services | Community Based Residential Treatment Facility, Mental Illness | 7002 Dallas Rd, Roanoke, VA 24019-1510 | 2007-08-27 |
| 1245369750 | Dominion Youth Services | Community Based Residential Treatment Facility, Mental Illness | 2407 Dumbarton Rd, Richmond, VA 23228-5909 | 2007-03-02 |
| 1649317918 | Dominion Youth Services | Community Based Residential Treatment Facility, Mental Illness | 2504 Prestwick Circle, Richmond, VA 23294 | 2007-01-30 |
| 1548353246 | Dominion Youth Services | Community Based Residential Treatment Facility, Mental Illness | 8401 Mayland Drive, Suite C, Richmond, VA 23294 | 2006-10-02 |
| 1407993777 | Dominion Youth Services | Community Based Residential Treatment Facility, Mental Illness | 2419 Fon Du Lac Rd, Richmond, VA 23229 | 2007-01-30 |
| Street Address |
4802 NORTHRIDGE LANE |
| City | ROANOKE |
| State | VA |
| Zip Code | 24019 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053951301 | Christina Debra O'neal | Pharmacist | 6460 Grand Retreat Drive Apt 3037, Roanoke, VA 24019 | 2020-01-14 |
| 1235785114 | Amy M. Tharp | Pathology | 6600 Northside High School Rd., Roanoke, VA 24019 | 2019-08-15 |
| 1821586892 | Emtech Laboratories Inc. | Hearing Aid Equipment | 7745 Garland Circle, Roanoke, VA 24019 | 2018-04-25 |
| 1518471176 | Catherine Backus | Music Therapist | 8231 Williamson Rd, Roanoke, VA 24019 | 2017-11-18 |
| 1023475597 | Emily Howel; | Physical Therapy Assistant | 345 Bryant Rd, Roanoke, VA 24019 | 2016-01-28 |
| 1194060541 | St. Vincent's Home, Inc. | Day Training, Developmentally Disabled Services | 312 Whitwell Drive, Roanoke, VA 24019 | 2012-12-11 |
| 1215237946 | Wal-mart Stores East Lp | Technician/Technologist | 5350 Clearbrook Village Lane, Roanoke, VA 24019 | 2010-10-28 |
| 1396063160 | Affiliated Rehab, P.C. | Physical Therapist | 5012 Plantation Rd, Roanoke, VA 24019 | 2010-05-04 |
| 1487732673 | Family Preservation Services, Inc | Community/Behavioral Health | 2002 Dale Ave, Roanoke, VA 24019 | 2006-11-02 |
| 1417050931 | Virginia Cvs Pharmacy, L.L.C. | Durable Medical Equipment & Medical Supplies | 2633 Peters Creek Rd Nw, Roanoke, VA 24019 | 2006-09-07 |
| Find all providers in zip 24019 | ||||
| Taxonomy Code | 320800000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment Facility, Mental Illness |
| A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407175961 | Sessions of Success | Community Based Residential Treatment Facility, Mental Illness | 651 Peters Creek Rd Nw, Roanoke, VA 24017-4860 | 2010-05-24 |
| 1477790038 | Berry Mental Support Services | Community Based Residential Treatment Facility, Mental Illness | 5307 Twilight Rd, Roanoke, VA 24019-2521 | 2009-01-19 |
| 1083800593 | Camelot of Virginia, LLC | Community Based Residential Treatment Facility, Mental Illness | 1729 Patterson Ave Sw, Roanoke, VA 24016-3105 | 2007-09-18 |
| 1811180458 | Dominion Youth Services | Community Based Residential Treatment Facility, Mental Illness | 7002 Dallas Rd, Roanoke, VA 24019-1510 | 2007-08-27 |
| 1598963548 | Cee-breeze Personal Care Services, Inc. | Community Based Residential Treatment Facility, Mental Illness | 410 Elm Ave Sw, Roanoke, VA 24016-3920 | 2007-07-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508487901 | River City Residential Services, LLC | Community Based Residential Treatment Facility, Mental Illness | 2106 Hungary Rd, Richmond, VA 23228-2208 | 2020-04-27 |
| 1376178079 | Scott's Rehabilitative House | Community Based Residential Treatment Facility, Mental Illness | 104 Country Club Rd, Franklin, VA 23851-2983 | 2020-03-03 |
| 1386298354 | Quality Care Counseling Services, LLC | Community Based Residential Treatment Facility, Mental Illness | 18511 Rollingside Dr, South Chesterfield, VA 23834-1699 | 2019-07-29 |
| 1730690694 | Families United, LLC | Community Based Residential Treatment Facility, Mental Illness | 1801 Hayward Ave, Chesapeake, VA 23320-2231 | 2017-10-18 |
| 1427419035 | Powerhouse Unlimited | Community Based Residential Treatment Facility, Mental Illness | 418 N 25th St, Apt 260, Richmond, VA 23223-7564 | 2016-03-09 |
| 1700266277 | Jan's Residential Homes | Community Based Residential Treatment Facility, Mental Illness | 307 N High St, Blackstone, VA 23824-1421 | 2015-05-31 |
| 1225426083 | Divine Health Support LLC | Community Based Residential Treatment Facility, Mental Illness | 2050 Hanson Ln, Woodbridge, VA 22191-4545 | 2015-01-02 |
| 1063838126 | New Lifestyles, Inc | Community Based Residential Treatment Facility, Mental Illness | 230 W Boscawen St, Winchester, VA 22601-4118 | 2014-03-13 |
| 1053742049 | Pathways Youth Services LLC | Community Based Residential Treatment Facility, Mental Illness | 1010 Marions Trl, Halifax, VA 24558-3126 | 2013-12-02 |
| 1679905269 | Rest Haven LLC | Community Based Residential Treatment Facility, Mental Illness | 1005 Bland St, Norfolk, VA 23513-3386 | 2013-08-06 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on DOMINION YOUTH SERVICES.
| 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.