Provider Demographics
NPI:1417397084
Name:GUIDANCE TO SUCCESS YOUTH CLUB
Entity Type:Organization
Organization Name:GUIDANCE TO SUCCESS YOUTH CLUB
Other - Org Name:BRIGHTERSIDE BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:CHILLS
Authorized Official - Last Name:STABLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-805-9056
Mailing Address - Street 1:6500 HOLDREGE ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-1673
Mailing Address - Country:US
Mailing Address - Phone:402-464-1661
Mailing Address - Fax:402-325-0212
Practice Address - Street 1:6500 HOLDREGE ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-1673
Practice Address - Country:US
Practice Address - Phone:402-464-1661
Practice Address - Fax:402-325-0212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-27
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health