Provider Demographics
NPI:1154180644
Name:SCHS - YOUTH MOBILE CRISIS SERVICES IND
Entity type:Organization
Organization Name:SCHS - YOUTH MOBILE CRISIS SERVICES IND
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-306-2067
Mailing Address - Street 1:PO BOX 770
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-0770
Mailing Address - Country:US
Mailing Address - Phone:225-306-2067
Mailing Address - Fax:225-222-6543
Practice Address - Street 1:336 E RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:LA
Practice Address - Zip Code:70443-2710
Practice Address - Country:US
Practice Address - Phone:225-306-2060
Practice Address - Fax:225-308-2572
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHEAST COMMUNITY HEALTH SYSTEMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-18
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)