MEDICARE: THE YOUTH LIGHT FOUNDATION, 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	251B00000X	Case Management Agency	000701	CT

General Provider Information

NPI Number	:	1750522967
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE YOUTH LIGHT FOUNDATION, INC

Provider Business Mailing Address
First Line	:	PO BOX 1655
Second Line	:
City	:	LITCHFIELD
State	:	CT
Zip	:	06759-1655
Country	:	US
Telephone Number	:	860-567-0700
Fax Number	:	860-567-5901

Provider Business Practice Location Address
First Line	:	3 WEST ST
Second Line	:
City	:	LITCHFIELD
State	:	CT
Zip	:	06759-3501
Country	:	US
Telephone Number	:	860-567-0700
Fax Number	:	860-567-5901

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	LAURA CLARK
Credential	:
Telephone Number	:	860-567-0700

Provider Enumeration Date	:	03/18/2009
Last Update Date	:	03/18/2009

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Directions to “THE YOUTH LIGHT FOUNDATION, INC ” Practice Location

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