NPIMap

Organization Active NPI

Dominion Youth Services

Doing business as Dominion Youth Services Residential LLC

  • Mental Illness Community Based Residential Treatment Facility
  • Richmond, VA
National Provider Identifier
1407993777
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
406-14-001 Issued in VA
Legal business name
DOMINION YOUTH SERVICES
Doing business as
Dominion Youth Services Residential LLC
Practice address
2419 Fon Du Lac Rd
Richmond, VA 23229
Phone
(804) 440-7074
Fax
(804) 440-7075
NPI assigned
Jan 30, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. GL Pulliam Jr., MS
Title
Director of Residential
Phone
(804) 285-9838

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X 406-14-001 VA Primary

Addresses

Primary practice location

2419 Fon Du Lac Rd
Richmond, VA 23229

Mailing address

PO Box 70296
Richmond, VA 23255-0296
Phone (804) 285-9838

Other names 1

  • Dominion Youth Services Residential LLC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dominion ABA7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1407993777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70296",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232550296",
            "telephone_number": "804-285-9838",
            "fax_number": "804-285-9839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2419 FON DU LAC RD",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "23229",
            "telephone_number": "804-440-7074",
            "fax_number": "804-440-7075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOMINION YOUTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PULLIAM",
        "authorized_official_first_name": "GL",
        "authorized_official_title_or_position": "DIRECTOR OF RESIDENTIAL",
        "authorized_official_telephone_number": "804-285-9838",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MS"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "VA",
            "license": "406-14-001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dominion Youth Services Residential LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Richmond, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.