Provider Demographics
NPI:1245317205
Name:YOUTH OPPORTUNITIES UPHELD, INC.
Entity type:Organization
Organization Name:YOUTH OPPORTUNITIES UPHELD, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-983-1300
Mailing Address - Street 1:135 GOLD STAR BLVD
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2738
Mailing Address - Country:US
Mailing Address - Phone:150-845-9640
Mailing Address - Fax:508-849-5618
Practice Address - Street 1:135 GOLD STAR BLVD
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-2738
Practice Address - Country:US
Practice Address - Phone:150-845-9640
Practice Address - Fax:508-849-5618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4429261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000000034307OtherBOSTON MEDICAL CENTER
MA000000034311OtherBOSTON MEDICAL CENTER
MA311121OtherTRICARE
MA000000034308OtherBOSTON MEDICAL CENTER
MAM18588OtherBCBSMA
MA001484OtherVALUE OPTIONS
MA148828000OtherCHILDRENS MEDICAL CMSP
MA000000034309OtherBOSTON MEDICAL CENTER
MA1307665Medicaid
MA197401000OtherCHILDRENS MEDICAL CMSP
MA7475389OtherAETNA
MA106249OtherMAGELLAN
MA1307665OtherMBHP
MA000000020417OtherBOSTON MEDICAL CENTER
MA00000034310OtherBOSTON MEDICAL CENTER
MA1003280OtherBEACON HEALTH STRATEGIES
MA802801OtherTUFTS HEALTH PLAN
MA197403000OtherCHILDRENS MEDICAL CMSP
MA988587OtherNETWORK HEALTH
MA1003280OtherBEACON HEALTH STRATEGIES