Provider Demographics
NPI:1962736850
Name:YOUTH TRANSITIONAL SERVICES, INC.
Entity type:Organization
Organization Name:YOUTH TRANSITIONAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DOLPHUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-526-3288
Mailing Address - Street 1:2879 HIGHWAY 160 W
Mailing Address - Street 2:STE 4388
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8581
Mailing Address - Country:US
Mailing Address - Phone:803-526-3288
Mailing Address - Fax:803-675-5233
Practice Address - Street 1:4501 W TYVOLA RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-6753
Practice Address - Country:US
Practice Address - Phone:803-526-3288
Practice Address - Fax:803-675-5233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-24
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCBT036Medicaid