MEDICARE: NATIONAL YOUTH ADVOCATE PROGRAM, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1093963332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL YOUTH ADVOCATE PROGRAM, INC

Provider Business Mailing Address
First Line	:	1801 WATERMARK DR
Second Line	:	SUITE 200
City	:	COLUMBUS
State	:	OH
Zip	:	43215-7088
Country	:	US
Telephone Number	:	614-487-8758
Fax Number	:	614-487-8759

Provider Business Practice Location Address
First Line	:	1020 WOODMAN DR
Second Line	:	SUITE 330
City	:	DAYTON
State	:	OH
Zip	:	45432-1446
Country	:	US
Telephone Number	:	937-253-0606
Fax Number	:	937-253-0707

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MARVENA TWIGG
Credential	:
Telephone Number	:	614-487-8758

Provider Enumeration Date	:	08/28/2008
Last Update Date	:	08/28/2008

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