Provider Demographics
NPI:1497972319
Name:YOUTH ENRICHMENT SERVICES OF LKN, INC.
Entity Type:Organization
Organization Name:YOUTH ENRICHMENT SERVICES OF LKN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-660-0973
Mailing Address - Street 1:635 W MCLELLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-3140
Mailing Address - Country:US
Mailing Address - Phone:704-660-0973
Mailing Address - Fax:704-663-6692
Practice Address - Street 1:635 W MCLELLAND AVE
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-3140
Practice Address - Country:US
Practice Address - Phone:704-660-0973
Practice Address - Fax:704-663-6692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5153144251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health