Provider Demographics
NPI:1114690047
Name:GRACE YOUTH MENTORING AND COMMUNITY OUTREACH INC.
Entity Type:Organization
Organization Name:GRACE YOUTH MENTORING AND COMMUNITY OUTREACH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWSOME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-344-3450
Mailing Address - Street 1:558 DENBIGH BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-4240
Mailing Address - Country:US
Mailing Address - Phone:757-218-1918
Mailing Address - Fax:757-210-4021
Practice Address - Street 1:558 DENBIGH BLVD STE A
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-4240
Practice Address - Country:US
Practice Address - Phone:757-218-1918
Practice Address - Fax:757-210-4021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-27
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness