ETOWAH YOUTH SERVICES INC. (NPI# 1760576797) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760576797 |
| Entity Type | Organization |
| Organization Name | ETOWAH YOUTH SERVICES INC. |
| Other Organization Name | EAGLE ROCK BOYS RANCH |
| Practice Address |
832 Burgess Rd Attalla AL 35954-5119 |
| Practice Telephone | 2565381687 |
| Practice Fax Number | 2565380646 |
| Mailing Telephone | 2565381687 |
| Mailing Fax Number | 2565380646 |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. SCOTT DAVID HILTON (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 2565381687 |
| Authorized Official Credential | M.A. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| Eagle Rock Boys Ranch | Doing Business As Name - Organization |
| Street Address |
832 BURGESS RD |
| City | ATTALLA |
| State | AL |
| Zip Code | 35954-5119 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346702438 | Amber Thomas | Social Worker | 306 7th Ave Nw, Attalla, AL 35954 | 2019-04-05 |
| 1609900042 | Edwin Scott Cornelius | Pharmacist | 1433 3rd Street S.w, Attalla, AL 35954-0490 | 2007-03-16 |
| 1245344456 | Medi-age Pharmaceuticals Inc | Pharmacy | 1433 3rd St Sw, Attalla, AL 35954-1132 | 2006-08-18 |
| 1053444562 | Ricky Bearden | Pharmacist | 1433 3rd St Sw, Attalla, AL 35954-1132 | 2007-03-13 |
| 1578742128 | Mary Jane Quinn | Developmental Therapist | 708 5th St Nw, Attalla, AL 35954-2007 | 2007-10-31 |
| 1972575819 | Andrew Willcox Reiland | Family Medicine | 515 3rd St Nw, Attalla, AL 35954-2022 | 2006-02-04 |
| 1699747535 | Debora Susan Reiland | Family Medicine | 515 3rd St Nw, Attalla, AL 35954-2022 | 2006-02-04 |
| 1417929357 | North Alabama Family Practice, PC | Family Medicine | 515 3rd St Nw, Attalla, AL 35954-2022 | 2006-02-04 |
| 1215218904 | Renee Michelle Bellew | Counselor | 613 4th St Nw, Attalla, AL 35954-2034 | 2011-09-08 |
| 1285937847 | Sarrell Regional Dental Center for Public Health, Inc. | Dentist | 404 4th St Nw, Attalla, AL 35954-2203 | 2010-12-20 |
| Find all providers in zip 35954 | ||||
| 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 |
|---|---|---|---|---|
| 1952701112 | Tears Teens Empowerment Awareness With Resolutions, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 206 E Oak St, Tuskegee, AL 36083-1819 | 2014-08-25 |
| 1093068199 | Working On Womanhood Program | Residential Treatment Facility, Emotionally Disturbed Children | 6001 12th Ave E Ste B, Tuscaloosa, AL 35405-5163 | 2012-10-26 |
| 1568793362 | Sequel Tsi of Alabama, LLC New Directions | Residential Treatment Facility, Emotionally Disturbed Children | 318a Hamer Rd, Owens Cross Roads, AL 35763-9612 | 2010-01-19 |
| 1700116373 | Sequel Tsi of Paint Rock Valley, LLC | Residential Treatment Facility, Emotionally Disturbed Children | 3890 County Road 20, Trenton, AL 35774-7423 | 2010-01-05 |
| 1528398161 | Atonement Inc | Residential Treatment Facility, Emotionally Disturbed Children | 3570 11th St Ne, Tuscaloosa, AL 35404-1906 | 2010-01-04 |
| 1295064269 | Camellia Therapeutic Foster Agency LLC | Residential Treatment Facility, Emotionally Disturbed Children | 407 S Seale Rd, Phenix City, AL 36869-7304 | 2009-12-21 |
| 1740518117 | Moriah Christian Children's Home | Residential Treatment Facility, Emotionally Disturbed Children | 417 County Road 446, Dutton, AL 35744-8457 | 2009-11-24 |
| 1346482866 | Pinnacle Behavior Health, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 29495 Copperhead Lane, Elkmont, AL 35620 | 2009-03-30 |
| 1639347818 | Southeast Alabama Counseling & Behavioral Specialist | Residential Treatment Facility, Emotionally Disturbed Children | 407 Honeysuckle Rd Ste 207, Dothan, AL 36305 | 2008-02-11 |
| 1841480571 | Children's Aid Society | Residential Treatment Facility, Emotionally Disturbed Children | 181 West Valley Ave, Suite 300, Homewood, AL 35209-3698 | 2007-07-30 |
| Find all providers with the same taxonomy | ||||
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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.