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NPI Code Detail

MEDICARE: NEW CHOICES YOUTH & FAMILY SERVICES, INC.

MEDICARE: NEW CHOICES YOUTH & FAMILY SERVICES, 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
1251S00000XCommunity/Behavioral Health AgencyFL

General Provider Information

NPI Number : 1639502792
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEW CHOICES YOUTH & FAMILY SERVICES, INC.
Provider Business Mailing Address
First Line : 5104 REAGAN DR STE 7
Second Line :
City : CHARLOTTE
State : NC
Zip : 28206-1392
Country : US
Telephone Number : 704-352-4870
Fax Number :
Provider Business Practice Location Address
First Line : 5104 REAGAN DR STE 7
Second Line :
City : CHARLOTTE
State : NC
Zip : 28206-1392
Country : US
Telephone Number : 704-352-4870
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : SAKEENAH L DAVID
Credential :
Telephone Number : 980-254-4744
Provider Enumeration Date : 08/13/2013
Last Update Date : 08/13/2013

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