Provider Demographics
NPI:1366749186
Name:YOUTH & FAMILY CENTER
Entity type:Organization
Organization Name:YOUTH & FAMILY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:YOUTH COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:EDGARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-856-1389
Mailing Address - Street 1:356B BROAD ST
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-3054
Mailing Address - Country:US
Mailing Address - Phone:508-856-1400
Mailing Address - Fax:
Practice Address - Street 1:356B BROAD ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-3054
Practice Address - Country:US
Practice Address - Phone:508-856-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health