Restored Youth Services, LLC

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

RESTORED YOUTH SERVICES, LLC

Practice address

305 D St
N Wilkesboro, NC 28659-4345

Phone

(335) 990-0688

Fax

(336) 990-0687

NPI assigned

Oct 23, 2017

Organization subpart

No

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

Authorized official

Name

Melissa Runetta Pearson, BS

Title

Director

Phone

(336) 302-9451

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1508716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508716800000",
    "number": "1578074142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4223 BENTLEY DR",
            "city": "RANDLEMAN",
            "state": "NC",
            "postal_code": "273178306",
            "telephone_number": "336-302-9451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 D ST",
            "city": "N WILKESBORO",
            "state": "NC",
            "postal_code": "286594345",
            "telephone_number": "335-990-0688",
            "fax_number": "336-990-0687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORED YOUTH SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-23",
        "last_updated": "2017-10-23",
        "status": "A",
        "authorized_official_last_name": "PEARSON",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "RUNETTA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "336-302-9451",
        "authorized_official_credential": "BS"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Novant Health Medical Group, LLC
• Novant Health Medical Group, LLC
• Novant Health Medical Group, LLC
• Roseann Pawlyszyn, LCSW
• Procare Medical Clinic PLLC
• Rebecca Lynn Russell, MS CCC-SLP
• Andrew Schrag
• Patricia Flye Segee, LPA
• Zachary Shepherd
• Jeanette Shumate, RN

• All providers in N Wilkesboro, NC
• Mental Illness Community Based Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2017; 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.