Provider Demographics
NPI:1366980989
Name:ARTISTRY YOUTH IN MOTION
Entity type:Organization
Organization Name:ARTISTRY YOUTH IN MOTION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:DELVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-391-3655
Mailing Address - Street 1:6211 PEMBROKE RD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33023-2215
Mailing Address - Country:US
Mailing Address - Phone:954-391-3655
Mailing Address - Fax:786-657-3821
Practice Address - Street 1:805 NW 198TH ST
Practice Address - Street 2:MIAMI GARDENS
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-3103
Practice Address - Country:US
Practice Address - Phone:954-391-3655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health