Provider Demographics
NPI:1255472882
Name:CLARINDA YOUTH CORPORATION
Entity Type:Organization
Organization Name:CLARINDA YOUTH CORPORATION
Other - Org Name:CLARINDA ACADEMY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, CYC BOARD OF DIRECTORS
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-542-3103
Mailing Address - Street 1:1820 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARINDA
Mailing Address - State:IA
Mailing Address - Zip Code:51632-1165
Mailing Address - Country:US
Mailing Address - Phone:712-542-3103
Mailing Address - Fax:712-542-2907
Practice Address - Street 1:1820 N 16TH ST
Practice Address - Street 2:
Practice Address - City:CLARINDA
Practice Address - State:IA
Practice Address - Zip Code:51632-1165
Practice Address - Country:US
Practice Address - Phone:712-542-3103
Practice Address - Fax:712-542-2907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1104299Medicaid