1679627863 NPI number — YOUTH ADVOCATE PROGRAMS, INC.

Table of content: (NPI 1679627863)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679627863 NPI number — YOUTH ADVOCATE PROGRAMS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YOUTH ADVOCATE PROGRAMS, 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:
1679627863
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3899 NORTH FRONT ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARRISBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17110-1583
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-232-7580
Provider Business Mailing Address Fax Number:
717-233-2879

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3899 NORTH FRONT ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17110-1583
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-232-7580
Provider Business Practice Location Address Fax Number:
717-233-2879
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
IVORY
Authorized Official First Name:
GARY
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CEO & PRESIDENT
Authorized Official Telephone Number:
717-232-7580

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  100007480 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0016578 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: CBT018 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0016454 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100007480 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 940264 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0016462 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0016560 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 080579802 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0016896 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0016900 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0016420 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0016446 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0016659 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0016853 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0016888 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 012190500 . 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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