IDEA YOUTH SUCCESS CENTER (NPI# 1013397892) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013397892 |
| Entity Type | Organization |
| Organization Name | IDEA YOUTH SUCCESS CENTER |
| Practice Address |
1518 Vaughn Blvd Fort Worth TX 76105-2307 |
| Mailing Address |
608 Chapel Pl Cedar Hill TX 75104-1760 |
| Practice Telephone | 2145152079 |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2015-06-05 |
| Authorized Official Name | MRS. DETITRIA WOODARD (OWNER) |
| Authorized Official Telephone | 2145152079 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 3245S0500X |
Substance Abuse Rehabilitation Facility Specialization: Substance Abuse Treatment, Children |
Residential Treatment Facilities | ||
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | Residential Treatment Facilities |
| Street Address |
1518 VAUGHN BLVD |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76105-2307 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477030567 | Brandon Ronald Lee | Optometrist | 2644 E Berry St., Fort Worth, TX 76105 | 2018-07-23 |
| 1366935165 | National Vision, Inc. | Technician/Technologist | 2644 East Berry Street, Fort Worth, TX 76105 | 2018-06-07 |
| 1609363100 | Courtney Mae Gramley | Specialist/Technologist | 1201 Wesleyan St., Fort Worth, TX 76105 | 2018-04-19 |
| 1992213078 | Fresenius Medical Care Se Fort Worth, LLC | Clinic/Center | 3708 E Rosedale St, Fort Worth, TX 76105 | 2018-01-11 |
| 1285978692 | Wal-mart Stores Texas LLC | Technician/Technologist | 2900 Renaissance Square, Fort Worth, TX 76105 | 2012-11-26 |
| 1548584998 | Access Dental of Berry, P.a. | Dentist | 4201 E. Berry Street, Suite #15, Fort Worth, TX 76105 | 2010-03-15 |
| 1811211261 | Access Dental of Rosedale P.a. | Dentist | 3620 E. Rosedale Street, Fort Worth, TX 76105 | 2010-03-15 |
| 1396345799 | Danielle Hampton | Pharmacist | Walmart Pharmacy, 2900 Renaissance Square, Fort Worth, TX 76105 | 2020-10-27 |
| 1174041578 | Destonee Wilson | Physician Assistant | 1650 S Beach St, Fort Worth, TX 76105 | 2017-09-06 |
| 1184019929 | Sheelarani Joseph | Nurse Practitioner | 1650 S Beach St, Fort Worth, TX 76105 | 2015-03-30 |
| Find all providers in zip 76105 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740598127 | Trinity Transitional Care | Residential Treatment Facility, Emotionally Disturbed Children | 3509 Richardson Ct, Fort Worth, TX 76119-1713 | 2010-09-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063030054 | Life's Purpose | Residential Treatment Facility, Emotionally Disturbed Children | 1211 Lark Ln, Richmond, TX 77469-7803 | 2020-07-07 |
| 1588293112 | Angelica Marie Griffin | Residential Treatment Facility, Emotionally Disturbed Children | 12500 Shadowglen Trace 3204, Manor, TX 78653 | 2020-04-06 |
| 1639702236 | The Landing At Corpus Christi | Residential Treatment Facility, Emotionally Disturbed Children | 2058 Fm 665, Corpus Christi, TX 78415 | 2020-02-21 |
| 1083158943 | Pinnacle Hc LLC | Residential Treatment Facility, Emotionally Disturbed Children | 980 S Coit Rd, 1322, Prosper, TX 75078-2989 | 2016-12-12 |
| 1932558517 | The Eunice House, LLC | Residential Treatment Facility, Emotionally Disturbed Children | 1114 Watson Crossing Way, Houston, TX 77067-1627 | 2016-06-06 |
| 1033577119 | 2nd Chanze Organization | Residential Treatment Facility, Emotionally Disturbed Children | 27102 Breton Bridge Ct, Cypress, TX 77433-7552 | 2016-02-04 |
| 1780073452 | Oyin'da LLC | Residential Treatment Facility, Emotionally Disturbed Children | 5551 Latta Plantation Dr, Katy, TX 77449-1557 | 2015-01-17 |
| 1376883322 | Angels With Open Arms | Residential Treatment Facility, Emotionally Disturbed Children | 6435 Tumbling Creek Trl, Dallas, TX 75241-5915 | 2013-02-27 |
| 1316201981 | Treathem, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 2904 1st St, Bay City, TX 77414-6828 | 2012-06-28 |
| 1588939532 | Turning Point Children's Social Services | Residential Treatment Facility, Emotionally Disturbed Children | 2224 Spring Creek Dr, Spring, TX 77373-6138 | 2012-03-08 |
| Find all providers with the same taxonomy | ||||
| City | FORT WORTH |
| Zip Code | 76105 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.