| Youth Intensive Services | |
|
238 S Meridian Rd Youngstown OH 44509-2925 | |
| (330) 318-3436 | |
| (330) 319-8800 |
| Full Name | Youth Intensive Services |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 238 S Meridian Rd, Youngstown, Ohio |
| Authorized Official Name and Position | Dewayne Thompson (PRESIDENT/CEO) |
| Authorized Official Contact | 3303183436 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Youth Intensive Services 238 S Meridian Rd Youngstown OH 44509-2925 Ph: (330) 318-3436 | Youth Intensive Services 238 S Meridian Rd Youngstown OH 44509-2925 Ph: (330) 318-3436 |
| NPI Number | 1497128367 |
|---|---|
| Provider Enumeration Date | 11/02/2015 |
| Last Update Date | 12/16/2020 |
| Certification Date | 12/16/2020 |
| Medicare PECOS PAC ID | 2264718188 |
|---|---|
| Medicare Enrollment ID | O20170407000946 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497128367 | NPI | - | NPPES |
| 0098581 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 13528 (Ohio) | Primary |
| Provider Name | Amber L Kelley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376139279 PECOS PAC ID: 2365854262 Enrollment ID: I20201217002726 |
| Provider Name | Stephanie Lyle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497299945 PECOS PAC ID: 5991080681 Enrollment ID: I20210421000588 |
| Provider Name | Mason C Donahue |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093407736 PECOS PAC ID: 5193163954 Enrollment ID: I20240329002095 |
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