Provider Demographics
NPI:1861892416
Name:YOUTH ENRICHMENT SOLUTIONS INC.
Entity type:Organization
Organization Name:YOUTH ENRICHMENT SOLUTIONS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-687-4124
Mailing Address - Street 1:7101 W 12TH ST STE 301B
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-2463
Mailing Address - Country:US
Mailing Address - Phone:501-687-4124
Mailing Address - Fax:501-400-8188
Practice Address - Street 1:7101 W 12TH ST STE 301B
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-2463
Practice Address - Country:US
Practice Address - Phone:501-687-4124
Practice Address - Fax:501-400-8188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR203157742Medicaid