Healthcare Provider Details

I. General information

NPI: 1720817521
Provider Name (Legal Business Name): YOUNG ADULT INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2024
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SCALES PLZ APT 422
CLIFTON NJ
07013-4316
US

IV. Provider business mailing address

220 E 42ND ST
NEW YORK NY
10017-5835
US

V. Phone/Fax

Practice location:
  • Phone: 212-273-6100
  • Fax:
Mailing address:
  • Phone: 212-273-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: JODI MANDEL
Title or Position: DIRECTOR, REVENUE MANAGEMENT
Credential:
Phone: 212-273-6206