1902860182 NPI number — G4S YOUTH SERVICES, LLC

Table of content: (NPI 1902860182)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902860182 NPI number — G4S YOUTH SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
G4S YOUTH SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SECURICOR NEW CENTURY, LLC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902860182
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9609 GAYTON RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23238-4900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-754-1100
Provider Business Mailing Address Fax Number:
804-741-9515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
765 E SAINT JOHNS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HASTINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32145-3936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-692-2920
Provider Business Practice Location Address Fax Number:
904-692-3611
Provider Enumeration Date:
04/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BROWNE
Authorized Official First Name:
GAIL
Authorized Official Middle Name:
Y
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
804-754-1100

Provider Taxonomy Codes

  • Taxonomy code: 322D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0707546 00 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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