NPI 1013397892

Idea Youth Success Center

Organisation Emotionally Disturbed Childrens' Residential Treatment Facility Fort Worth, TX

Practice location

Address: 1518 Vaughn Blvd, Fort Worth, TX 76105-2307
Phone: (214) 515-2079
Mailing address: 608 Chapel Pl, Cedar Hill, TX 75104-1760

Authorised official

Name: Detitria Woodard
Title: Owner
Phone: (214) 515-2079

Registered specialties (2)

Emotionally Disturbed Childrens' Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 322D00000X

Other Residential Treatment Facility, Emotionally Disturbed Children providers in Texas →

Children's Substance Abuse Rehabilitation Facility

Residential Treatment Facilities Taxonomy 3245S0500X

Other Substance Abuse Rehabilitation Facility providers in Texas →

Registry record

NPI: 1013397892
Entity type: Organization
NPI issued: 5 Jun 2015
Record last updated: 5 Jun 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.