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General NPI Number Information
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NPI Number | 1043855851
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Entity Type | Organization
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Legal Business Name | YOUTH SERVICES NETWORK
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Dates
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Enumeration Date | 11/15/2019
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Last Update Date | 11/15/2019
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Provider Practice Location Address
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Address Line | 107 N 3RD ST
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City | ROCKFORD
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State | IL
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Zip | 61107-4010
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Country | US
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Telephone | 815-986-1947
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Fax | 815-986-1954
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Provider Business Mailing Address
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Address Line | 107 N 3RD ST
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City | ROCKFORD
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State | IL
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Zip | 61107-4010
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Country | US
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Telephone | 815-986-1947
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Fax | 815-986-1954
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Authorized Official
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Title or Position | ADMINISTRATIVE/LICENSING MANAGER
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Name | MELISSA BUCALO
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Credential |
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Telephone | 815-986-1947
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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