Provider Demographics
NPI:1043451669
Name:BROOKS & ASSOCIATES YOUTH SERVICES, LLC
Entity Type:Organization
Organization Name:BROOKS & ASSOCIATES YOUTH SERVICES, LLC
Other - Org Name:B&A YOUTH SERVICES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-755-2010
Mailing Address - Street 1:4450 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28470-4450
Mailing Address - Country:US
Mailing Address - Phone:910-755-2010
Mailing Address - Fax:910-755-2422
Practice Address - Street 1:4450 MAIN ST
Practice Address - Street 2:
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-4450
Practice Address - Country:US
Practice Address - Phone:910-755-2010
Practice Address - Fax:910-755-2422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301814Medicaid