Provider Demographics
NPI:1104153485
Name:AVERY YOUTH SERVICES FOR BOYS, INC.
Entity type:Organization
Organization Name:AVERY YOUTH SERVICES FOR BOYS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:AVERY
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-261-9688
Mailing Address - Street 1:742 MCKNIGHT DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-7764
Mailing Address - Country:US
Mailing Address - Phone:919-261-9688
Mailing Address - Fax:919-261-0118
Practice Address - Street 1:742 MCKNIGHT DR
Practice Address - Street 2:SUITE 201
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-7764
Practice Address - Country:US
Practice Address - Phone:919-261-9688
Practice Address - Fax:919-261-0118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-08
Last Update Date:2009-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management