1689327330 NPI number — NATIONAL YOUTH ADVOCATE PROGRAM, 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 1689327330 NPI number — NATIONAL YOUTH ADVOCATE PROGRAM, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATIONAL YOUTH ADVOCATE PROGRAM, 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:
1689327330
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1801 WATERMARK DR STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43215-7088
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-487-8758
Provider Business Mailing Address Fax Number:
614-487-8759

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1705 217TH PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAUK VILLAGE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60411-4462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-747-2655
Provider Business Practice Location Address Fax Number:
708-747-2859
Provider Enumeration Date:
02/02/2022

Additional Information

Authorized Official

Authorized Official Last Name:
OWENS
Authorized Official First Name:
SHELIA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF DEVELOPMENT
Authorized Official Telephone Number:
708-747-2655

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • 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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