1649516527 NPI number — NATIONAL YOUTH ADVOCATE PROGRAM

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 1649516527 NPI number — NATIONAL YOUTH ADVOCATE PROGRAM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATIONAL YOUTH ADVOCATE PROGRAM
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:
1649516527
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
Provider Second Line Business Mailing Address:
STE 200
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:
888-688-9964
Provider Business Mailing Address Fax Number:
614-487-3819

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2600 SANDCREST BLVD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47203-3053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-342-4220
Provider Business Practice Location Address Fax Number:
812-342-4250
Provider Enumeration Date:
12/20/2012

Additional Information

Authorized Official

Authorized Official Last Name:
TWIGG
Authorized Official First Name:
MARVENA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
888-688-9964

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)





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