Provider Demographics
NPI:1326383860
Name:CENTER FOR SAFE YOUTH LLC
Entity Type:Organization
Organization Name:CENTER FOR SAFE YOUTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGNEN
Authorized Official - Suffix:
Authorized Official - Credentials:BSA, LPI
Authorized Official - Phone:706-613-9007
Mailing Address - Street 1:PO BOX 81786
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30608-1786
Mailing Address - Country:US
Mailing Address - Phone:706-613-9007
Mailing Address - Fax:
Practice Address - Street 1:595 SANDSTONE DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-3437
Practice Address - Country:US
Practice Address - Phone:706-613-9007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)