Provider Demographics
NPI:1215417316
Name:Y.A.L.E. CLINIC, LLC
Entity Type:Organization
Organization Name:Y.A.L.E. CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-654-7222
Mailing Address - Street 1:10A JENNINGS RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-9524
Mailing Address - Country:US
Mailing Address - Phone:609-654-7222
Mailing Address - Fax:609-654-7224
Practice Address - Street 1:10A JENNINGS RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-9524
Practice Address - Country:US
Practice Address - Phone:609-654-7222
Practice Address - Fax:609-654-7224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services