1275764896 NPI number — APOSTOLIC YOUTH & FAMILY SERVICES

Table of content: (NPI 1275764896)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275764896 NPI number — APOSTOLIC YOUTH & FAMILY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APOSTOLIC YOUTH & 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:
1275764896
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4645 BROADWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARY
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46409-2461
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-981-4008
Provider Business Mailing Address Fax Number:
219-981-9273

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4645 BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46409-2461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-981-4008
Provider Business Practice Location Address Fax Number:
219-981-9273
Provider Enumeration Date:
07/30/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
CLIFTON
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
219-981-4008

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  20042301A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: 34001842A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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