Provider Demographics
NPI:1225524952
Name:COMMUNITY CARE YOUTH AND FAMILY CENTER
Entity Type:Organization
Organization Name:COMMUNITY CARE YOUTH AND FAMILY CENTER
Other - Org Name:N/A
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KEYORKA
Authorized Official - Middle Name:K
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-615-5549
Mailing Address - Street 1:2405 CAMELOT CT
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-1712
Mailing Address - Country:US
Mailing Address - Phone:504-615-5549
Mailing Address - Fax:
Practice Address - Street 1:2405 CAMELOT CT
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-1712
Practice Address - Country:US
Practice Address - Phone:504-615-5549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health