Provider Demographics
NPI:1346092988
Name:YOUTH RISING
Entity Type:Organization
Organization Name:YOUTH RISING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER & VP OF HR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:CEGLOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:CERT MGMT ACCOUNT
Authorized Official - Phone:540-494-2048
Mailing Address - Street 1:161 W UNIVERSITY PKWY # PO10461
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-1857
Mailing Address - Country:US
Mailing Address - Phone:540-494-2048
Mailing Address - Fax:877-920-0125
Practice Address - Street 1:700 KLAMATH AVE
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-6199
Practice Address - Country:US
Practice Address - Phone:540-494-2048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No174200000XOther Service ProvidersMeals
No177F00000XOther Service ProvidersLodging
No251B00000XAgenciesCase Management