Provider Demographics
NPI:1346381589
Name:YOUTH DEVELOPMENT CORPORATION OF AMERICA
Entity Type:Organization
Organization Name:YOUTH DEVELOPMENT CORPORATION OF AMERICA
Other - Org Name:CARING FAMILY NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEVELOPMENT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHREIBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-572-0001
Mailing Address - Street 1:6015 FAYETTEVILLE RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6254
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1700 E ASH ST
Practice Address - Street 2:BLDG A SUITE 302
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-4097
Practice Address - Country:US
Practice Address - Phone:919-736-4003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107468Medicaid