MEDICARE: YOUTH WITH A VISION MINISTRIES INCORPORATED

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	347C00000X	Private Vehicle
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1629660550
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUTH WITH A VISION MINISTRIES INCORPORATED

Provider Business Mailing Address
First Line	:	8016 W CLAYTON DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85033-2228
Country	:	US
Telephone Number	:	602-527-9164
Fax Number	:

Provider Business Practice Location Address
First Line	:	8016 W CLAYTON DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85033-2228
Country	:	US
Telephone Number	:	602-527-9164
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MS. SHERYL ELAINE NELSON
Credential	:
Telephone Number	:	602-527-9164

Provider Enumeration Date	:	02/11/2021
Last Update Date	:	02/11/2021

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