1245649896 NPI number — COMMUNITY OUTREACH FOR YOUTH AND FAMILY SERVICES OF MS

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 1245649896 NPI number — COMMUNITY OUTREACH FOR YOUTH AND FAMILY SERVICES OF MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY OUTREACH FOR YOUTH AND FAMILY SERVICES OF MS
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:
1245649896
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1514 CLEVELAND AVE STE 120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST POINT
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30344-6977
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-631-6383
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1514 CLEVELAND AVE STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST POINT
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30344-6977
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-631-6383
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/07/2014

Additional Information

Authorized Official

Authorized Official Last Name:
FRANCIS
Authorized Official First Name:
CORY
Authorized Official Middle Name:
TITO
Authorized Official Title or Position:
CEO/OWNER
Authorized Official Telephone Number:
919-423-2277

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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