Provider Demographics
NPI:1598358848
Name:100 REAL ARTS YOUTH CORPS
Entity Type:Organization
Organization Name:100 REAL ARTS YOUTH CORPS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-726-5876
Mailing Address - Street 1:331 E MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-5384
Mailing Address - Country:US
Mailing Address - Phone:704-726-5876
Mailing Address - Fax:
Practice Address - Street 1:331 E MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-5384
Practice Address - Country:US
Practice Address - Phone:704-726-5876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-18
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1245750041Medicaid