Provider Demographics
NPI:1427867340
Name:CHILDREN AND YOUNG ADULT SERVICES
Entity type:Organization
Organization Name:CHILDREN AND YOUNG ADULT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SIBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-910-7396
Mailing Address - Street 1:47526 CLIPPER ST UNIT 1254
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-7166
Mailing Address - Country:US
Mailing Address - Phone:810-494-1673
Mailing Address - Fax:
Practice Address - Street 1:39514 ROCKCREST LN
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-3960
Practice Address - Country:US
Practice Address - Phone:810-494-1673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251V00000XAgenciesVoluntary or Charitable
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services