Provider Demographics
NPI:1104295237
Name:BOYS ON THE RIGHT TRACK
Entity type:Organization
Organization Name:BOYS ON THE RIGHT TRACK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIET
Authorized Official - Middle Name:
Authorized Official - Last Name:MEADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-316-1789
Mailing Address - Street 1:1597 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:LAKE VIEW
Mailing Address - State:NY
Mailing Address - Zip Code:14085-9567
Mailing Address - Country:US
Mailing Address - Phone:716-316-1789
Mailing Address - Fax:
Practice Address - Street 1:1597 EVERGREEN DR
Practice Address - Street 2:
Practice Address - City:LAKE VIEW
Practice Address - State:NY
Practice Address - Zip Code:14085-9567
Practice Address - Country:US
Practice Address - Phone:716-316-1789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251V00000X251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable