Provider Demographics
NPI:1912277831
Name:INSTITUTE OF YOUTH DEVELOPMENT AND EXCELLENCE
Entity type:Organization
Organization Name:INSTITUTE OF YOUTH DEVELOPMENT AND EXCELLENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RIYAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-297-3955
Mailing Address - Street 1:2232 STRATFORD AVE
Mailing Address - Street 2:STE 220
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-1202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2232 STRATFORD AVE
Practice Address - Street 2:STE 220
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-1202
Practice Address - Country:US
Practice Address - Phone:513-297-3955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management