Provider Demographics
NPI:1538735238
Name:NATIONAL YOUTH ADVOCATE PROGRAM, INC
Entity type:Organization
Organization Name:NATIONAL YOUTH ADVOCATE PROGRAM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF DEVELOPMENT AND SUPPORT
Authorized Official - Prefix:
Authorized Official - First Name:SHELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-747-2655
Mailing Address - Street 1:4801 SOUTHWICK DR STE 300
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-2279
Mailing Address - Country:US
Mailing Address - Phone:708-747-2655
Mailing Address - Fax:708-747-2859
Practice Address - Street 1:1115 N NORTH ST STE C
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61606-1959
Practice Address - Country:US
Practice Address - Phone:708-747-2655
Practice Address - Fax:708-747-2859
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIONAL YOUTH ADVOCATE PROGRAM, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)