NPIMap

Organization Active NPI

Youth Image, Inc.

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Morganton, NC
National Provider Identifier
1417131210
Registry record updated Dec 28, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
MHL 012-111 Issued in NC
Legal business name
YOUTH IMAGE, INC.
Practice address
107 Kela Dr
Morganton, NC 28655-7868
Phone
(828) 439-1705
Fax
(828) 433-4486
NPI assigned
Dec 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2007

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

Authorized official

Name
Mr. Ralph Edward Collette
Title
President
Phone
(828) 433-4485

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X MHL 012-111 NC Primary

Addresses

Primary practice location

107 Kela Dr
Morganton, NC 28655-7868

Mailing address

PO Box 914
Morganton, NC 28680-0914
Phone (828) 433-4485

Other names 1

  • N/A Other name

National Provider Directory

National Provider Directory
Tax ID family
Youth Image Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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": "1198800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198800000000",
    "number": "1417131210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 914",
            "city": "MORGANTON",
            "state": "NC",
            "postal_code": "286800914",
            "telephone_number": "828-433-4485",
            "fax_number": "828-433-4486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 KELA DR",
            "city": "MORGANTON",
            "state": "NC",
            "postal_code": "286557868",
            "telephone_number": "828-439-1705",
            "fax_number": "828-433-4486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOUTH IMAGE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-28",
        "last_updated": "2007-12-28",
        "status": "A",
        "authorized_official_last_name": "COLLETTE",
        "authorized_official_first_name": "RALPH",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "828-433-4485",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL 012-111",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "N/A",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Morganton, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2007; 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.