Healthcare Provider Details

I. General information

NPI: 1114150661
Provider Name (Legal Business Name): YOUTH DEVELOPMENT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2009
Last Update Date: 09/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 EL CENTRO FAMILIAR BLVD SW # 87105
ALBUQUERQUE NM
87105-4502
US

IV. Provider business mailing address

1710 EL CENTRO FAMILIAR BLVD SW # 87105
ALBUQUERQUE NM
87105-4502
US

V. Phone/Fax

Practice location:
  • Phone: 505-873-1604
  • Fax: 505-877-3533
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. LYNDA MOORE
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 505-873-1604