Provider Demographics
NPI:1306382734
Name:ACHIEVEMENT FOR DISABLED YOUTH
Entity Type:Organization
Organization Name:ACHIEVEMENT FOR DISABLED YOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-824-3306
Mailing Address - Street 1:1090 UNIVERSITY AVE APT E3
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-4219
Mailing Address - Country:US
Mailing Address - Phone:646-824-3306
Mailing Address - Fax:
Practice Address - Street 1:1090 UNIVERSITY AVE APT E3
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-4219
Practice Address - Country:US
Practice Address - Phone:646-824-3306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251C00000X, 302F00000X, 385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child