NPIMap

Organization Active NPI

Favor Youth Services, Inc.

  • Community/Behavioral Health Agency
  • Gastonia, NC
National Provider Identifier
1639231194
Registry record updated Nov 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
251S00000X Issued in NC
Legal business name
FAVOR YOUTH SERVICES, INC.
Practice address
1568 Union Rd Ste a
Gastonia, NC 28054-2211
Phone
(704) 866-9177
Fax
(704) 866-9176
NPI assigned
Dec 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2009

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

Authorized official

Name
Mr. Sean Tramalle Gray, QMHP
Title
Executive Director
Phone
(704) 866-9177

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X 251B00000X NC
Developmentally Disabled Services Day Training Agency 251C00000X 251C00000X NC
Community/Behavioral Health Agency 251S00000X 251S00000X NC Primary

Addresses

Primary practice location

1568 Union Rd Ste a
Gastonia, NC 28054-2211

Mailing address

1568 Union Rd Ste a
Gastonia, NC 28054-2211
Phone (704) 866-9177

Other identifiers 2

IdentifierTypeStateIssuer
3418155OtherNCCAP NUMBER
8300200BMedicaidNC

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1258329600000",
    "number": "1639231194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1568 UNION RD STE A",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280542211",
            "telephone_number": "704-866-9177",
            "fax_number": "704-866-9176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1568 UNION RD STE A",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280542211",
            "telephone_number": "704-866-9177",
            "fax_number": "704-866-9176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAVOR YOUTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-14",
        "last_updated": "2009-11-16",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "SEAN",
        "authorized_official_middle_name": "TRAMALLE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "704-866-9177",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "QMHP"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NC",
            "license": "251B00000X",
            "primary": false
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "NC",
            "license": "251C00000X",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "251S00000X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAP NUMBER",
            "identifier": "3418155",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300200B",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gastonia, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2009; 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.