Provider Demographics
NPI:1285790014
Name:YOUTH OPPORTUNITIES
Entity type:Organization
Organization Name:YOUTH OPPORTUNITIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CONRAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-724-1412
Mailing Address - Street 1:7670 NORTHPOINT CT.
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3336
Mailing Address - Country:US
Mailing Address - Phone:336-724-1412
Mailing Address - Fax:336-724-1464
Practice Address - Street 1:2020 E. 12TH ST.
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-1805
Practice Address - Country:US
Practice Address - Phone:336-724-1412
Practice Address - Fax:336-724-1464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301014RMedicaid
NC8301014Medicaid