Healthcare Provider Details

I. General information

NPI: 1013577493
Provider Name (Legal Business Name): YOUNG ADULT INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 THE TERRACE
PLANDOME NY
11030
US

IV. Provider business mailing address

460 W 34TH ST FL 11
NEW YORK NY
10001-2320
US

V. Phone/Fax

Practice location:
  • Phone: 212-273-6206
  • Fax:
Mailing address:
  • Phone: 212-273-6206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

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