Healthcare Provider Details
I. General information
NPI: 1245317205
Provider Name (Legal Business Name): YOUTH OPPORTUNITIES UPHELD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 11/01/2006
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:
III. Provider practice location address
135 GOLD STAR BLVD
WORCESTER MA
01606-2738
US
IV. Provider business mailing address
135 GOLD STAR BLVD
WORCESTER MA
01606-2738
US
V. Phone/Fax
- Phone: 150-845-9640
- Fax: 508-849-5618
- Phone: 150-845-9640
- Fax: 508-849-5618
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 261QM0801X |
| Taxonomy | Mental Health Clinic/Center (Including Community Mental Health Center) |
| License Number | 4429 |
| License Number State | MA |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 000000034307 |
| Identifier Type | OTHER |
| Identifier State | MA |
| Identifier Issuer | BOSTON MEDICAL CENTER |
| # 2 | |
| Identifier | 000000034311 |
| Identifier Type | OTHER |
| Identifier State | MA |
| Identifier Issuer | BOSTON MEDICAL CENTER |
| # 3 | |
| Identifier | 311121 |
| Identifier Type | OTHER |
| Identifier State | MA |
| Identifier Issuer | TRICARE |
| # 4 | |
| Identifier | 000000034308 |
| Identifier Type | OTHER |
| Identifier State | MA |
| Identifier Issuer | BOSTON MEDICAL CENTER |
| # 5 | |
| Identifier | M18588 |
| Identifier Type | OTHER |
| Identifier State | MA |
| Identifier Issuer | BCBSMA |
| # 6 | |
| Identifier | 001484 |
| Identifier Type | OTHER |
| Identifier State | MA |
| Identifier Issuer | VALUE OPTIONS |
| # 7 | |
| Identifier | 148828000 |
| Identifier Type | OTHER |
| Identifier State | MA |
| Identifier Issuer | CHILDRENS MEDICAL CMSP |
| # 8 | |
| Identifier | 000000034309 |
| Identifier Type | OTHER |
| Identifier State | MA |
| Identifier Issuer | BOSTON MEDICAL CENTER |
| # 9 | |
| Identifier | 1307665 |
| Identifier Type | MEDICAID |
| Identifier State | MA |
| Identifier Issuer | |
| # 10 | |
| Identifier | 197401000 |
| Identifier Type | OTHER |
| Identifier State | MA |
| Identifier Issuer | CHILDRENS MEDICAL CMSP |
| # 11 | |
| Identifier | 7475389 |
| Identifier Type | OTHER |
| Identifier State | MA |
| Identifier Issuer | AETNA |
| # 12 | |
| Identifier | 106249 |
| Identifier Type | OTHER |
| Identifier State | MA |
| Identifier Issuer | MAGELLAN |
| # 13 | |
| Identifier | 1307665 |
| Identifier Type | OTHER |
| Identifier State | MA |
| Identifier Issuer | MBHP |
| # 14 | |
| Identifier | 000000020417 |
| Identifier Type | OTHER |
| Identifier State | MA |
| Identifier Issuer | BOSTON MEDICAL CENTER |
| # 15 | |
| Identifier | 00000034310 |
| Identifier Type | OTHER |
| Identifier State | MA |
| Identifier Issuer | BOSTON MEDICAL CENTER |
| # 16 | |
| Identifier | 1003280 |
| Identifier Type | OTHER |
| Identifier State | MA |
| Identifier Issuer | BEACON HEALTH STRATEGIES |
| # 17 | |
| Identifier | 802801 |
| Identifier Type | OTHER |
| Identifier State | MA |
| Identifier Issuer | TUFTS HEALTH PLAN |
| # 18 | |
| Identifier | 197403000 |
| Identifier Type | OTHER |
| Identifier State | MA |
| Identifier Issuer | CHILDRENS MEDICAL CMSP |
| # 19 | |
| Identifier | 988587 |
| Identifier Type | OTHER |
| Identifier State | MA |
| Identifier Issuer | NETWORK HEALTH |
VIII. Authorized Official
Name: MR.
DAVID
JORDAN
Title or Position: PRESIDENT CEO
Credential:
Phone: 508-983-1300
