Provider Demographics
NPI:1083892798
Name:COMMUNITY OUTREACH FOR YOUTH & FAMILY SERVICES OF GA
Entity Type:Organization
Organization Name:COMMUNITY OUTREACH FOR YOUTH & FAMILY SERVICES OF GA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
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
Mailing Address - Street 2:SUITE 120
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-6965
Mailing Address - Country:US
Mailing Address - Phone:919-423-2277
Mailing Address - Fax:
Practice Address - Street 1:1514 CLEVELAND AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-6965
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:2008-02-05
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health