Youth Academy, Llc | |
3 Crosswinds Dr Fairmont WV 26554-9193 | |
(304) 363-3341 | |
(304) 363-3342 |
Full Name | Youth Academy, Llc |
---|---|
Speciality | Community/behavioral Health |
Location | 3 Crosswinds Dr, Fairmont, West Virginia |
Authorized Official Name and Position | Steven W Fairley (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 3043633341 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Youth Academy, Llc 3 Crosswinds Dr Fairmont WV 26554-9193 Ph: (304) 363-3341 | Youth Academy, Llc 3 Crosswinds Dr Fairmont WV 26554-9193 Ph: (304) 363-3341 |
NPI Number | 1891913935 |
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Provider Enumeration Date | 04/23/2007 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1891913935 | NPI | - | NPPES |
3810003254 | Medicaid | WV |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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