1003031436 NPI number — FAMILIES & YOUTH, INC

Table of content: (NPI 1003031436)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003031436 NPI number — FAMILIES & YOUTH, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILIES & YOUTH, 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:
FYI
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:
1003031436
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1868
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS CRUCES
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88004-1868
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-522-4004
Provider Business Mailing Address Fax Number:
505-522-9017

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1320 S. SOLANO DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS CRUCES
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88001-3758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-522-4004
Provider Business Practice Location Address Fax Number:
505-522-9017
Provider Enumeration Date:
04/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KAVANAUGH
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
575-644-0485

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 322D00000X , with the licence number: 1077A , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: B9814 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: M1497 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: M0161 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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