Provider Demographics
NPI:1992230486
Name:DESTINY YOUTH EMPOWERMENT PROGRAM
Entity type:Organization
Organization Name:DESTINY YOUTH EMPOWERMENT PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:O
Authorized Official - Last Name:ANOZIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-881-2800
Mailing Address - Street 1:623 MERCURY AVE
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75137-2235
Mailing Address - Country:US
Mailing Address - Phone:832-881-2800
Mailing Address - Fax:972-283-6661
Practice Address - Street 1:623 MERCURY AVE
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75137-2235
Practice Address - Country:US
Practice Address - Phone:832-881-2800
Practice Address - Fax:972-283-6661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health