NPIMap

Organization Active NPI

Intercept Youth Services, Inc.

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Chesterfield, VA
National Provider Identifier
1902907314
Registry record updated Sep 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
295-14-010 Issued in VA
Legal business name
INTERCEPT YOUTH SERVICES, INC.
Practice address
3400 Newbys Bridge Rd
Chesterfield, VA 23832-7828
Phone
(804) 726-8690
Fax
(804) 726-8692
NPI assigned
Sep 26, 2006
Last updated
Sep 24, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2020

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

Authorized official

Name
Don Kamencik
Title
Cfo
Phone
(804) 864-1320

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X 295-14-010 VA Primary

Addresses

Primary practice location

3400 Newbys Bridge Rd
Chesterfield, VA 23832-7828

Mailing address

5511 Staples Mill Rd
Suite 102
Richmond, VA 23228-5445
Phone (804) 864-1320

Other identifiers 1

IdentifierTypeStateIssuer
010090415MedicaidVA

National Provider Directory

National Provider Directory
Tax ID family
Intercept Youth Services Inc15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600905600000",
    "number": "1902907314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5511 STAPLES MILL RD",
            "address_2": "SUITE 102",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232285445",
            "telephone_number": "804-864-1320",
            "fax_number": "804-864-1323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 NEWBYS BRIDGE RD",
            "city": "CHESTERFIELD",
            "state": "VA",
            "postal_code": "238327828",
            "telephone_number": "804-726-8690",
            "fax_number": "804-726-8692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERCEPT YOUTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-26",
        "last_updated": "2020-09-24",
        "certification_date": "2020-09-24",
        "status": "A",
        "authorized_official_last_name": "KAMENCIK",
        "authorized_official_first_name": "DON",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "804-864-1320"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "VA",
            "license": "295-14-010",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010090415",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesterfield, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 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.