Healthcare Provider Details

I. General information

NPI: 1831012632
Provider Name (Legal Business Name): EDUCATING YOUTH THROUGH EMPOWERMENT CAMP CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 ERIE ST
SYRACUSE NY
13204-1710
US

IV. Provider business mailing address

112 ERIE ST
SYRACUSE NY
13204-1710
US

V. Phone/Fax

Practice location:
  • Phone: 864-402-9891
  • Fax:
Mailing address:
  • Phone:
  • 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
# 2
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: TANIKKI S GREGORY
Title or Position: OWNER
Credential:
Phone: 315-726-2558