Provider Demographics
NPI:1073167755
Name:NUFOUNDATION YOUTH DEVELOPMENT MENTORS AND LIFE COACH SERVICES
Entity Type:Organization
Organization Name:NUFOUNDATION YOUTH DEVELOPMENT MENTORS AND LIFE COACH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KELVIN
Authorized Official - Middle Name:DONYELL
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:951-467-8466
Mailing Address - Street 1:27349 JEFFERSON AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5612
Mailing Address - Country:US
Mailing Address - Phone:951-466-3032
Mailing Address - Fax:855-568-2494
Practice Address - Street 1:27349 JEFFERSON AVE STE 204
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5612
Practice Address - Country:US
Practice Address - Phone:951-466-3032
Practice Address - Fax:855-568-2494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-30
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty