Provider Demographics
NPI:1497472211
Name:BACK TO BASICS YOUTH EDUCATION
Entity Type:Organization
Organization Name:BACK TO BASICS YOUTH EDUCATION
Other - Org Name:BACK TO BASICS YOUTH EDUCATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-248-5360
Mailing Address - Street 1:1014 MERRYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-2445
Mailing Address - Country:US
Mailing Address - Phone:937-248-5360
Mailing Address - Fax:
Practice Address - Street 1:120 W 2ND ST STE 611
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-1657
Practice Address - Country:US
Practice Address - Phone:937-248-5360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-24
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH12234Medicaid