Provider Demographics
NPI:1326232240
Name:YOUTH HOME INCORPORATED
Entity type:Organization
Organization Name:YOUTH HOME INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SCEALITA
Authorized Official - Middle Name:
Authorized Official - Last Name:DRENNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-663-7667
Mailing Address - Street 1:5109 W 23RD ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-5101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5109 W 23RD ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-5101
Practice Address - Country:US
Practice Address - Phone:501-663-7667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children