Provider Demographics
NPI:1902241227
Name:NOAH'S ARK YOUTH AND FAMILY SERVICES LLC
Entity Type:Organization
Organization Name:NOAH'S ARK YOUTH AND FAMILY SERVICES LLC
Other - Org Name:NAYFS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HUMAN RESOURCES DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GENTRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-517-9990
Mailing Address - Street 1:120 COLONY CENTER DR STE 204
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-6219
Mailing Address - Country:US
Mailing Address - Phone:770-517-9990
Mailing Address - Fax:
Practice Address - Street 1:120 COLONY CENTER DR STE 204
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-6219
Practice Address - Country:US
Practice Address - Phone:770-517-9990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-30
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness