Provider Demographics
NPI:1114161825
Name:THE YOUTH SUCCESS NETWORK - COMMUNILINK AND MHO
Entity Type:Organization
Organization Name:THE YOUTH SUCCESS NETWORK - COMMUNILINK AND MHO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:M
Authorized Official - Middle Name:WELLESLEY
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-897-6465
Mailing Address - Street 1:16 WEST MAIN ST
Mailing Address - Street 2:FLOOR 2
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728
Mailing Address - Country:US
Mailing Address - Phone:888-897-6465
Mailing Address - Fax:877-438-8976
Practice Address - Street 1:16 W MAIN ST
Practice Address - Street 2:FLOOR 2
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2210
Practice Address - Country:US
Practice Address - Phone:888-897-6465
Practice Address - Fax:877-438-8976
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE YOUTH SUCCESS NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-24
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ64669006251S00000X
NJPENDING385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child