Provider Demographics
NPI:1285880328
Name:YOUTH CARE CENTER
Entity type:Organization
Organization Name:YOUTH CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:812-421-3806
Mailing Address - Street 1:727 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47713-1823
Mailing Address - Country:US
Mailing Address - Phone:812-421-3806
Mailing Address - Fax:812-421-3804
Practice Address - Street 1:727 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-1823
Practice Address - Country:US
Practice Address - Phone:812-421-3806
Practice Address - Fax:812-421-3804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN4206533124251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health