Provider Demographics
NPI:1154486900
Name:YOUTH EMPOWERMENT ZONE LLC
Entity Type:Organization
Organization Name:YOUTH EMPOWERMENT ZONE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:856-776-2200
Mailing Address - Street 1:1601 N 2ND ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-1924
Mailing Address - Country:US
Mailing Address - Phone:856-776-2200
Mailing Address - Fax:856-776-2209
Practice Address - Street 1:1601 N 2ND ST
Practice Address - Street 2:SUITE B
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-1924
Practice Address - Country:US
Practice Address - Phone:856-776-2200
Practice Address - Fax:856-776-2209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health