Provider Demographics
NPI:1063749869
Name:NEIGHBORHOOD YOUTH LEADERSHIP
Entity type:Organization
Organization Name:NEIGHBORHOOD YOUTH LEADERSHIP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEINZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-695-1004
Mailing Address - Street 1:140 SOUTHERN DUNES DR
Mailing Address - Street 2:
Mailing Address - City:VASS
Mailing Address - State:NC
Mailing Address - Zip Code:28394-9218
Mailing Address - Country:US
Mailing Address - Phone:910-692-1004
Mailing Address - Fax:
Practice Address - Street 1:140 SOUTHERN DUNES DR
Practice Address - Street 2:
Practice Address - City:VASS
Practice Address - State:NC
Practice Address - Zip Code:28394-9218
Practice Address - Country:US
Practice Address - Phone:910-692-1004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)