Provider Demographics
NPI:1679886006
Name:YOUTH DIMENSIONS
Entity type:Organization
Organization Name:YOUTH DIMENSIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:LARON
Authorized Official - Last Name:NEWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-213-9000
Mailing Address - Street 1:3385 AUSTIN PEAY HWY
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-3810
Mailing Address - Country:US
Mailing Address - Phone:901-213-9000
Mailing Address - Fax:901-213-9771
Practice Address - Street 1:3385 AUSTIN PEAY HWY
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-3810
Practice Address - Country:US
Practice Address - Phone:901-213-9000
Practice Address - Fax:901-213-9771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1621323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility