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1770428328 NPI number — JUVENILE UPLIFTING MENTORING PROGRAM

NPI Number: 1770428328
Health Care Provider/Practitioner: JUVENILE UPLIFTING MENTORING PROGRAM

Information about “1770428328” NPI (JUVENILE UPLIFTING MENTORING PROGRAM) exists in 1770428328 in HTML format HTML  |  1770428328 in plain Text format TXT  |  1770428328 in PDF (Portable Document Format) PDF  |  1770428328 in an XML format XML  formats.

NPI Number : 1770428328 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1770428328",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "JUVENILE UPLIFTING MENTORING PROGRAM",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "293 MAIN ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WILLIAMSPORT",
    "MailingAddressStateName": "PA",
    "MailingAddressPostalCode": "17702-7312",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "267-326-7959",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "734 W 4TH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WILLIAMSPORT",
    "PracticeLocationAddressStateName": "PA",
    "PracticeLocationAddressPostalCode": "17701-5904",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "267-326-7959",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/21/2026",
    "LastUpdateDate": "04/21/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "MARTIN",
    "AuthorizedOfficialFirstName": "INTISAR",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "EXECUTIVE DIRECTOR",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "CRS, MS",
    "AuthorizedOfficialTelephoneNumber": "267-326-7959",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "251B00000X",
          "TaxonomyName": "Case Management Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3245S0500X",
          "TaxonomyName": "Children's Substance Abuse Rehabilitation Facility",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "251S00000X",
          "TaxonomyName": "Community/Behavioral Health Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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