MEDICARE: YOUTH DEVELOPMENT CORPORATION OF AMERICA

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942341177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUTH DEVELOPMENT CORPORATION OF AMERICA

Provider Business Mailing Address
First Line	:	5611 NC HIGHWAY 55
Second Line	:	SUITE 101
City	:	DURHAM
State	:	NC
Zip	:	27713-4395
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2905 BREEZEWOOD AVE
Second Line	:	SUITE 101
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-5503
Country	:	US
Telephone Number	:	910-223-9927
Fax Number	:

Authorized Official
Title or Position	:	BILLING SPECIALIST SUPERVISOR
Name	:	BRELYN WADDELL
Credential	:
Telephone Number	:	919-323-8090

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	08/10/2010

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Directions to “YOUTH DEVELOPMENT CORPORATION OF AMERICA ” Practice Location

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