Provider Demographics
NPI:1063727295
Name:ALEXANDER YOUTH NETWORK
Entity type:Organization
Organization Name:ALEXANDER YOUTH NETWORK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTRACT MGR.
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-366-8712
Mailing Address - Street 1:7670 NORTHPOINT CT.
Mailing Address - Street 2:
Mailing Address - City:WISNTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3336
Mailing Address - Country:US
Mailing Address - Phone:336-724-1412
Mailing Address - Fax:336-724-1464
Practice Address - Street 1:7670 NORTHPOINT CT.
Practice Address - Street 2:
Practice Address - City:WISNTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3336
Practice Address - Country:US
Practice Address - Phone:336-724-1412
Practice Address - Fax:336-724-1464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-12
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5916066Medicaid