Provider Demographics
NPI:1093585366
Name:TAKING BACK OUR YOUTH
Entity Type:Organization
Organization Name:TAKING BACK OUR YOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAKANYA
Authorized Official - Middle Name:LATASHA SARVERA
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-799-9944
Mailing Address - Street 1:3441 W 52ND ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-5817
Mailing Address - Country:US
Mailing Address - Phone:216-799-9944
Mailing Address - Fax:
Practice Address - Street 1:2012 W 25TH ST FL 7
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-4135
Practice Address - Country:US
Practice Address - Phone:216-799-9944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No171W00000XOther Service ProvidersContractorGroup - Multi-Specialty