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General NPI Number Information
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NPI Number | 1376416388
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Entity Type | Organization
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Legal Business Name | URBAN YOUTH AGRICULTURE
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Dates
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Enumeration Date | 09/25/2025
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 14455 WILSHIRE DRIVE
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City | DETROIT
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State | MI
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Zip | 48213
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Country | US
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Telephone | 248-259-9715
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Fax |
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Provider Business Mailing Address
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Address Line | 23450 BEVERLY ST
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City | OAK PARK
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State | MI
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Zip | 48237-1971
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PROGRAM ASSISTANT
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Name | KENNEDY TAYLOR
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Credential |
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Telephone | 248-259-9715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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