Healthcare Provider Details

I. General information

NPI: 1346033057
Provider Name (Legal Business Name): URBANA YOUTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2025
Last Update Date: 05/26/2025
Certification Date: 05/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 W MARKET ST
URBANA OH
43078-2019
US

IV. Provider business mailing address

160 W MARKET ST
URBANA OH
43078-2019
US

V. Phone/Fax

Practice location:
  • Phone: 937-772-4022
  • Fax: 937-772-4022
Mailing address:
  • Phone: 937-772-4022
  • Fax: 937-772-4022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: TAMMI R FEEHAN
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 937-772-4022