1497179238 NPI number — HOYLETON YOUTH AND FAMILY SERVICES

Table of content: (NPI 1497179238)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497179238 NPI number — HOYLETON YOUTH AND FAMILY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOYLETON YOUTH AND FAMILY SERVICES
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:
1497179238
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 218
Provider Second Line Business Mailing Address:
350 NORTH MAIN STREET
Provider Business Mailing Address City Name:
HOYLETON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62803-0311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-493-7283
Provider Business Mailing Address Fax Number:
618-493-6390

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2636 VILLA PARK DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGHLAND
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62249-9999
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-654-8914
Provider Business Practice Location Address Fax Number:
618-654-8782
Provider Enumeration Date:
02/14/2014

Additional Information

Authorized Official

Authorized Official Last Name:
COX
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
618-493-7382

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  010020 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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