=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093438848
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YOU EMPOWER YOU FOUNDATION, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2022
-----------------------------------------------------
Last Update Date | 04/24/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1038 HENDERSON DR
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28540-7422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-333-1250
-----------------------------------------------------
Fax | 910-719-9050
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1038 HENDERSON DR
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28540-7422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-333-1250
-----------------------------------------------------
Fax | 910-719-9050
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROGRAM & DEVELOPMENT OFFICER
-----------------------------------------------------
Name | MR. PATRICK ROBBINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 910-264-3902
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------