1164689238 NPI number — FAMILY AND YOUTH INTERVENTIONS, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164689238 NPI number — FAMILY AND YOUTH INTERVENTIONS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY AND YOUTH INTERVENTIONS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FYI, LLC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164689238
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 BUFORD HIGHWAY
Provider Second Line Business Mailing Address:
SUITE R4
Provider Business Mailing Address City Name:
SUGAR HILL
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30518-8777
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-804-8823
Provider Business Mailing Address Fax Number:
678-804-8827

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 BUFORD HIGHWAY
Provider Second Line Business Practice Location Address:
SUITE R4
Provider Business Practice Location Address City Name:
SUGAR HILL
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30518-8777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-804-8823
Provider Business Practice Location Address Fax Number:
678-804-8827
Provider Enumeration Date:
05/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GILL
Authorized Official First Name:
MARGIE
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
678-804-8823

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com