Provider Demographics
NPI:1114568532
Name:LANCASTER YOUTH LEADERSHIP & DEVELOPMENT PROGRAM
Entity Type:Organization
Organization Name:LANCASTER YOUTH LEADERSHIP & DEVELOPMENT PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CEDRIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-246-9009
Mailing Address - Street 1:2810 C B REEVES RD
Mailing Address - Street 2:
Mailing Address - City:HEATH SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29058-8906
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:916 15TH STREET
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720
Practice Address - Country:US
Practice Address - Phone:803-246-9009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable