Provider Demographics
NPI:1083015366
Name:COMMUNITY OUTREACH FOR YOUTH AND FAMILY SERVICES OF VA LLC
Entity Type:Organization
Organization Name:COMMUNITY OUTREACH FOR YOUTH AND FAMILY SERVICES OF VA LLC
Other - Org Name:AMERICAN FAMILY CARE NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:TITO
Authorized Official - Last Name:FRANCIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-423-2277
Mailing Address - Street 1:1514 CLEVELAND AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-6977
Mailing Address - Country:US
Mailing Address - Phone:919-423-2277
Mailing Address - Fax:
Practice Address - Street 1:1514 CLEVELAND AVE STE 120
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-6977
Practice Address - Country:US
Practice Address - Phone:919-423-2277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health