Provider Demographics
NPI:1497896617
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:BILLING SPECIALIST SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:BRELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WADDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-323-8090
Mailing Address - Street 1:5611 NC HIGHWAY 55
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-4395
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1214 VAUGHN RD
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-2863
Practice Address - Country:US
Practice Address - Phone:336-227-5050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005704Medicaid
NC8300205Medicaid
2341543AMedicare UPIN
NC8300205Medicaid