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General NPI Number Information
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NPI Number | 1497972319
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Entity Type | Organization
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Legal Business Name | YOUTH ENRICHMENT SERVICES OF LKN, INC.
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 08/22/2007
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Provider Practice Location Address
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Address Line | 635 W MCLELLAND AVE
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City | MOORESVILLE
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State | NC
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Zip | 28115-3140
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Country | US
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Telephone | 704-660-0973
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Fax | 704-663-6692
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Provider Business Mailing Address
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Address Line | 635 W MCLELLAND AVE
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City | MOORESVILLE
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State | NC
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Zip | 28115-3140
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Country | US
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Telephone | 704-660-0973
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Fax | 704-663-6692
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Authorized Official
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Title or Position | CEO
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Name | MR. JIM CARR
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Credential |
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Telephone | 704-660-0973
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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 | 5153144
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License Number State | NC
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