Provider Demographics
NPI:1215077664
Name:YOUTH AND FAMILY RESIDENTIAL TREATMENT CENTER INC.
Entity type:Organization
Organization Name:YOUTH AND FAMILY RESIDENTIAL TREATMENT CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MED PHD
Authorized Official - Phone:910-829-0443
Mailing Address - Street 1:3406 BOONE TRL
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-2138
Mailing Address - Country:US
Mailing Address - Phone:910-829-0443
Mailing Address - Fax:910-829-0446
Practice Address - Street 1:808 CLIFTWOOD DR
Practice Address - Street 2:
Practice Address - City:SILER CITY
Practice Address - State:NC
Practice Address - Zip Code:27344-2302
Practice Address - Country:US
Practice Address - Phone:919-742-2626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-019-035320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603797Medicaid