Provider Demographics
NPI:1003374422
Name:NATIONAL YOUTH ADVOCATE PROGRAM, INC
Entity Type:Organization
Organization Name:NATIONAL YOUTH ADVOCATE PROGRAM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID BILLING SPECIALIST II
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:LIZARDI
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:614-227-9430
Mailing Address - Street 1:1801 WATERMARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-7088
Mailing Address - Country:US
Mailing Address - Phone:888-202-2965
Mailing Address - Fax:614-487-8759
Practice Address - Street 1:3631 EDISON RD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46615-3715
Practice Address - Country:US
Practice Address - Phone:800-270-3756
Practice Address - Fax:219-293-8604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)