Provider Demographics
NPI:1154918704
Name:ONE STEP TWO STEP OPERATION HOPE & AT RISK YOUTH SERVICES
Entity type:Organization
Organization Name:ONE STEP TWO STEP OPERATION HOPE & AT RISK YOUTH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR V.P.
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:KEITH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:704-919-1733
Mailing Address - Street 1:2121 VILLAGE LAKE DR APT 150
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-0068
Mailing Address - Country:US
Mailing Address - Phone:704-726-8645
Mailing Address - Fax:
Practice Address - Street 1:2121 VILLAGE LAKE DR APT 150
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-0068
Practice Address - Country:US
Practice Address - Phone:704-726-8645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-30
Last Update Date:2021-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Single Specialty