Healthcare Provider Details

I. General information

NPI: 1295935435
Provider Name (Legal Business Name): EVERYONE'S YOUTH UNITED, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 43RD ST S
SAINT PETERSBURG FL
33711-1921
US

IV. Provider business mailing address

700 43RD ST S
SAINT PETERSBURG FL
33711-1921
US

V. Phone/Fax

Practice location:
  • Phone: 727-321-0060
  • Fax: 727-321-0951
Mailing address:
  • Phone: 727-321-0060
  • Fax: 727-321-0951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License NumberSR-52-AD-604601
License Number StateFL

VIII. Authorized Official

Name: MRS. DONNA WELCH
Title or Position: INTERIM CEO/ BOARD SECRETARY
Credential:
Phone: 727-321-0060