Basic Information
Provider Information | |||||||||
NPI: | 1942431432 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | HAND UP HOMES FOR YOUTH, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 740699 | ||||||||
Address2: | SUITE 212 | ||||||||
City: | ARVADA | ||||||||
State: | CO | ||||||||
PostalCode: | 800060699 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3033180311 | ||||||||
FaxNumber: | 3033180288 | ||||||||
Practice Location | |||||||||
Address1: | 4192 WEST HIGHWAY 70 | ||||||||
Address2: |   | ||||||||
City: | MARION | ||||||||
State: | NC | ||||||||
PostalCode: | 287527547 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8284398191 | ||||||||
FaxNumber: | 8284392622 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/31/2009 | ||||||||
LastUpdateDate: | 08/03/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | WILSON | ||||||||
AuthorizedOfficialFirstName: | LAURA | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | EXECUTIVE ADMINISTRATOR | ||||||||
AuthorizedOfficialTelephone: | 3033180311 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 322D00000X | MHL-059-042 | NC | Y |   | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children |   |
No ID Information.