Provider Demographics
NPI:1861575532
Name:YOUTH ENHANCEMENT ALTERNATIVE HOMES LLC
Entity type:Organization
Organization Name:YOUTH ENHANCEMENT ALTERNATIVE HOMES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:AUNDREY
Authorized Official - Middle Name:C
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS,QDDP
Authorized Official - Phone:910-815-2667
Mailing Address - Street 1:PO BOX 2042
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28402-2042
Mailing Address - Country:US
Mailing Address - Phone:910-815-2667
Mailing Address - Fax:
Practice Address - Street 1:2169 HARRISON ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6921
Practice Address - Country:US
Practice Address - Phone:910-815-2667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408747Medicaid
NC8300724Medicaid
NC8301678Medicaid