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General NPI Number Information
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NPI Number | 1306977756
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Entity Type | Organization
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Legal Business Name | YOUNG AT HEART RESOURCES
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 12/11/2020
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Provider Practice Location Address
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Address Line | 809 N 13TH ST
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City | ALBANY
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State | MO
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Zip | 64402-2035
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Country | US
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Telephone | 660-240-9400
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Fax | 660-726-4113
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Provider Business Mailing Address
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Address Line | PO BOX 265
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City | ALBANY
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State | MO
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Zip | 64402-0265
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Country | US
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Telephone | 660-726-3800
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Fax | 660-726-4113
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Authorized Official
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Title or Position | CEO
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Name | MICHAEL STOPKA
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Credential |
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Telephone | 660-240-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number | 288100605
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License Number State | MO
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