NPIMap

Organization Active NPI

Dominion Youth Services

  • Mental Illness Community Based Residential Treatment Facility
  • Roanoke, VA
National Provider Identifier
1952562811
Registry record updated Jun 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
40614077 Issued in VA
Legal business name
DOMINION YOUTH SERVICES
Practice address
4802 Northridge Lane
Roanoke, VA 24019
Phone
(540) 366-3080
Fax
(540) 366-3081
NPI assigned
Jun 23, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2008

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 40614077 VA Primary

Addresses

Primary practice location

4802 Northridge Lane
Roanoke, VA 24019

Mailing address

8401 Mayland Drive
Suite C
Richmond, VA 23294
Phone (804) 285-9838

Other identifiers 1

IdentifierTypeStateIssuer
406-14-077OtherVADMH LICENSE

Other names 1

  • Dominion Youth Services Residential 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.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1214179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214179200000",
    "number": "1952562811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8401 MAYLAND DRIVE",
            "address_2": "SUITE C",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "23294",
            "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": "4802 NORTHRIDGE LANE",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "24019",
            "telephone_number": "540-366-3080",
            "fax_number": "540-366-3081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOMINION YOUTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-23",
        "last_updated": "2008-06-23",
        "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": "40614077",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMH LICENSE",
            "identifier": "406-14-077",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dominion Youth Services Residential",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Roanoke, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2008; 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.