Healthcare Provider Details

I. General information

NPI: 1942672670
Provider Name (Legal Business Name): NATIONAL YOUTH ADVOCATE PROGRAM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2015
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W HILLSBORO BLVD STE 2-205
DEERFIELD BEACH FL
33441-1616
US

IV. Provider business mailing address

1801 WATERMARK DR STE 200
COLUMBUS OH
43215-7088
US

V. Phone/Fax

Practice location:
  • Phone: 877-490-6644
  • Fax: 954-596-5286
Mailing address:
  • Phone: 888-202-2965
  • Fax: 614-487-8759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MARVENA TWIGG
Title or Position: PRESIDENT/CEO
Credential:
Phone: 888-202-2965