MEDICARE: ASSURANCE FOR TOMORROWS LEADERS YOUTH FOUNDATION, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1609132935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSURANCE FOR TOMORROWS LEADERS YOUTH FOUNDATION, INC.

Provider Business Mailing Address
First Line	:	2439 DELACHAISE ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70115-6123
Country	:	US
Telephone Number	:	504-452-0110
Fax Number	:	888-552-2718

Provider Business Practice Location Address
First Line	:	2439 DELACHAISE ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70115-6123
Country	:	US
Telephone Number	:	504-452-0110
Fax Number	:	888-552-2718

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR/CEO
Name	:	MS. ANNETTE JONES
Credential	:	M.A.
Telephone Number	:	504-452-0110

Provider Enumeration Date	:	04/11/2012
Last Update Date	:	04/11/2012

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