Provider Demographics
NPI:1578731501
Name:YOUTH SERVICE PROJECT
Entity Type:Organization
Organization Name:YOUTH SERVICE PROJECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUNIGA-BALDWIN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:773-772-6270
Mailing Address - Street 1:3942 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-4639
Mailing Address - Country:US
Mailing Address - Phone:773-772-6270
Mailing Address - Fax:773-772-8755
Practice Address - Street 1:3942 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-4639
Practice Address - Country:US
Practice Address - Phone:773-772-6270
Practice Address - Fax:773-772-8755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency