Provider Demographics
NPI:1275353070
Name:YOUTH SOLUTIONS HOME LLC
Entity type:Organization
Organization Name:YOUTH SOLUTIONS HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANNON
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:JETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-626-9610
Mailing Address - Street 1:748 ALEXANDER COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-7650
Mailing Address - Country:US
Mailing Address - Phone:704-557-6558
Mailing Address - Fax:
Practice Address - Street 1:6305 LYNWOOD DR NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-3824
Practice Address - Country:US
Practice Address - Phone:704-803-2972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health