Provider Demographics
NPI:1154724516
Name:UNIFIED FAMILY& YOUTH NETWORK INC
Entity type:Organization
Organization Name:UNIFIED FAMILY& YOUTH NETWORK INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BLESSING
Authorized Official - Middle Name:N
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:508-427-6334
Mailing Address - Street 1:418 BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4955
Mailing Address - Country:US
Mailing Address - Phone:508-427-6334
Mailing Address - Fax:
Practice Address - Street 1:418 BELMONT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4955
Practice Address - Country:US
Practice Address - Phone:508-427-6334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-30
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS81121038253J00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No253J00000XAgenciesFoster Care Agency