1942489331 NPI number — YOUTH TRAIN VENTURES

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 1942489331 NPI number — YOUTH TRAIN VENTURES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YOUTH TRAIN VENTURES
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:
1942489331
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
909A SOUTH MAIN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURLINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-222-8522
Provider Business Mailing Address Fax Number:
336-222-8533

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3309B NORTH CAROLINA HIGHWAY 49 NORTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-222-8522
Provider Business Practice Location Address Fax Number:
336-222-8533
Provider Enumeration Date:
11/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
WENDY
Authorized Official Middle Name:
RENEE
Authorized Official Title or Position:
PROGRAM DIRECTOR
Authorized Official Telephone Number:
336-222-8522

Provider Taxonomy Codes

  • Taxonomy code: 322D00000X , with the licence number:  MHL-001-100 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6603321 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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