1487187704 NPI number — YOUTH OPPORTUNITY INVESTMENTS, LLC

Table of content: REBECCA GARRETT (NPI 1306034525)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487187704 NPI number — YOUTH OPPORTUNITY INVESTMENTS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YOUTH OPPORTUNITY INVESTMENTS, 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:
Provider Other Organization Name Type Code:
6
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:
1487187704
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12775 HORSEFERRY RD STE 230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARMEL
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46032-7265
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-587-8880
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
696 N FM 487
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKDALE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76567-6005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-446-3930
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/04/2017

Additional Information

Authorized Official

Authorized Official Last Name:
HUNTER
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
317-587-8880

Provider Taxonomy Codes

  • Taxonomy code: 323P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: L0000000025629 . This is a "LICENSE - DEPARTMENT OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 114277100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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