Provider Demographics
NPI:1285985069
Name:CENTER FOR YOUTH EXCELLENCE
Entity type:Organization
Organization Name:CENTER FOR YOUTH EXCELLENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KOFI
Authorized Official - Middle Name:OTHIENA
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-412-4754
Mailing Address - Street 1:1409 KEARNY ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2957
Mailing Address - Country:US
Mailing Address - Phone:202-412-4754
Mailing Address - Fax:202-315-3746
Practice Address - Street 1:1409 KEARNY ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2957
Practice Address - Country:US
Practice Address - Phone:202-412-4754
Practice Address - Fax:202-315-3746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children