1205525813 NPI number — WE UNITE YOUTH DEVELOPMENT INITIATIVE, INC.

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 1205525813 NPI number — WE UNITE YOUTH DEVELOPMENT INITIATIVE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WE UNITE YOUTH DEVELOPMENT INITIATIVE, INC.
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:
Provider Other Organization Name Type Code:
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:
1205525813
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
851 WENDOVER BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTON SHORES
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49441-5053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-747-5862
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3025 GLADE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUSKEGON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-747-6862
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/01/2023

Additional Information

Authorized Official

Authorized Official Last Name:
KNOX
Authorized Official First Name:
MELLANIE
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
248-298-9215

Provider Taxonomy Codes

  • Taxonomy code: 174200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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