1912020678 NPI number — JOHNNYS HEROES YOUTH AND FAMILY SERVICES, INC.

Table of content: (NPI 1912020678)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912020678 NPI number — JOHNNYS HEROES YOUTH AND FAMILY SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHNNYS HEROES YOUTH AND FAMILY SERVICES, INC.
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:
Provider Other Organization Name Type Code:
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:
1912020678
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 5549
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-370-9963
Provider Business Mailing Address Fax Number:
804-782-0186

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1026 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-791-4208
Provider Business Practice Location Address Fax Number:
434-791-4206
Provider Enumeration Date:
04/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NEWMAN
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
SYLVESTER
Authorized Official Title or Position:
C.A.O.
Authorized Official Telephone Number:
804-370-9963

Provider Taxonomy Codes

  • Taxonomy code: 320600000X , with the licence number:  662-14-001 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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