Organization Name: | MOUNTAIN YOUTH ACADEMY |
NPI Number: | 1083832117 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CLARA E. SMITH (THERAPIST) |
Mailing Address: | 332 Hospital Rd Mountain City |
State: | TN US |
Postal Code: | 376834309 |
Phone Number: | 4237279898 |
Fax Number: | 4237279899 |
NPI Enumeration Date: | 04/23/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320600000X |
License Number: | L237M21261695 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | TN |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
Taxonomy Specialization: | |
Taxonomy Definition: | A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |