Provider Demographics
NPI:1316283443
Name:H.Y.P.E. HEALTHY YOUTH PURSUING EXCELLENCE
Entity type:Organization
Organization Name:H.Y.P.E. HEALTHY YOUTH PURSUING EXCELLENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:O
Authorized Official - Last Name:HOUSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-933-9446
Mailing Address - Street 1:55 KRISTEN PL
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-6649
Mailing Address - Country:US
Mailing Address - Phone:678-933-9446
Mailing Address - Fax:
Practice Address - Street 1:55 KRISTEN PL
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-6649
Practice Address - Country:US
Practice Address - Phone:678-933-9446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization