Provider Demographics
NPI:1801933528
Name:TOWERGATE YOUTH AND FAMILY SERVICES, INC.
Entity type:Organization
Organization Name:TOWERGATE YOUTH AND FAMILY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LESSANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-701-2123
Mailing Address - Street 1:PO BOX 822
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28026-0822
Mailing Address - Country:US
Mailing Address - Phone:704-701-2123
Mailing Address - Fax:704-795-1882
Practice Address - Street 1:201 W MAIN ST
Practice Address - Street 2:SUITE B16
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-3228
Practice Address - Country:US
Practice Address - Phone:704-701-2123
Practice Address - Fax:704-793-1882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-060-822251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301758BMedicaid
NC8301758GMedicaid