1003374422 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 1003374422 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:
1003374422
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2019
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:
888-202-2965
Provider Business Mailing Address Fax Number:
614-487-8759

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3631 EDISON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH BEND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46615-3715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-270-3756
Provider Business Practice Location Address Fax Number:
219-293-8604
Provider Enumeration Date:
03/05/2019

Additional Information

Authorized Official

Authorized Official Last Name:
LIZARDI
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
YVONNE
Authorized Official Title or Position:
MEDICAID BILLING SPECIALIST II
Authorized Official Telephone Number:
614-227-9430

Provider Taxonomy Codes

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

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





Copyright © 2007-2025 www.npivalidator.com