Provider Demographics
NPI:1326649500
Name:AFRICAN YOUTH AND COMMUNITY ORGANIZATION
Entity Type:Organization
Organization Name:AFRICAN YOUTH AND COMMUNITY ORGANIZATION
Other - Org Name:AYCO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-475-8802
Mailing Address - Street 1:432 NE 74TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-6312
Mailing Address - Country:US
Mailing Address - Phone:971-254-8916
Mailing Address - Fax:
Practice Address - Street 1:1390 SE 122ND AVE STE UE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-1203
Practice Address - Country:US
Practice Address - Phone:971-254-8916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-04
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity HealthGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty