NPIViewer - Provider NPI 1306884069

NPI:	1306884069
Name:	UNITED YOUTH CARE SERVICES
Entity type:	Organization
Organization Name:	UNITED YOUTH CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:	CEO
Authorized Official - Prefix:	MR
Authorized Official - First Name:	DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:	BOOKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:	336-370-9232
Mailing Address - Street 1:	1207 4TH ST
Mailing Address - Street 2:
Mailing Address - City:	GREENSBORO
Mailing Address - State:	NC
Mailing Address - Zip Code:	27405-6622
Mailing Address - Country:	US
Mailing Address - Phone:	336-370-9232
Mailing Address - Fax:
Practice Address - Street 1:	1207 4TH STREET
Practice Address - Street 2:
Practice Address - City:	GREENSBORO
Practice Address - State:	NC
Practice Address - Zip Code:	27405
Practice Address - Country:	US
Practice Address - Phone:	336-370-9232
Practice Address - Fax:
EIN:	<UNAVAIL>
Is Organization Subpart?:	No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:	2006-06-03
Last Update Date:	2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:

Primary?	Code	Type	Classification	Specialization	Group
Yes	291U00000X	Laboratories	Clinical Medical Laboratory
No	261QP2300X	Ambulatory Health Care Facilities	Clinic/Center	Primary Care	Group - Multi-Specialty
No	261QR0405X	Ambulatory Health Care Facilities	Clinic/Center	Rehabilitation, Substance Use Disorder	Group - Multi-Specialty
No	251B00000X	Agencies	Case Management		Group - Multi-Specialty
No	207K00000X	Allopathic & Osteopathic Physicians	Allergy & Immunology		Group - Multi-Specialty
No	251S00000X	Agencies	Community/Behavioral Health		Group - Multi-Specialty
No	207KA0200X	Allopathic & Osteopathic Physicians	Allergy & Immunology	Allergy	Group - Multi-Specialty
No	261QC1500X	Ambulatory Health Care Facilities	Clinic/Center	Community Health
No	261QH0100X	Ambulatory Health Care Facilities	Clinic/Center	Health Service
No	261QM0801X	Ambulatory Health Care Facilities	Clinic/Center	Mental Health (Including Community Mental Health Center)
No	207KI0005X	Allopathic & Osteopathic Physicians	Allergy & Immunology	Clinical & Laboratory Immunology	Group - Multi-Specialty

State	Identifier ID	ID Type
NC	8300941	Medicaid
NC	8300941H	Medicaid
NC	8300934G	Medicaid
NC	8300016H	Medicaid
NC	60 06024	Medicaid
NC	8300016B	Medicaid
NC	8300016G	Medicaid
NC	6006013	Medicaid
NC	8300016K	Medicaid
NC	8300934	Medicaid
NC	8300934B	Medicaid
NC	8300016	Medicaid
NC	8300934H	Medicaid
NC	8300941G	Medicaid
NC	3408412	Medicaid
NC	6006025	Medicaid
NC	8300941B	Medicaid
NC	8300016F	Medicaid