1760693915 NPI number — FAMILY & YOUTH INSTITUTE 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 1760693915 NPI number — FAMILY & YOUTH INSTITUTE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY & YOUTH INSTITUTE 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:
BETTERSELF
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:
1760693915
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4010 DONALBAIN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77373-7441
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-748-0233
Provider Business Mailing Address Fax Number:
832-481-6495

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26009 BUDDE RD STE A300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THE WOODLANDS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77380-2065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-748-0233
Provider Business Practice Location Address Fax Number:
832-481-6495
Provider Enumeration Date:
05/26/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GENTRY
Authorized Official First Name:
CATHERINE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
832-748-7999

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 18604 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YS0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 179480201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".