Provider Demographics
NPI:1609166370
Name:UPSIDE TO YOUTH DEVELOPMENT,LLC
Entity Type:Organization
Organization Name:UPSIDE TO YOUTH DEVELOPMENT,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:C
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-541-7894
Mailing Address - Street 1:320 E BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:23860-2812
Mailing Address - Country:US
Mailing Address - Phone:804-541-7894
Mailing Address - Fax:804-541-7895
Practice Address - Street 1:320 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-2812
Practice Address - Country:US
Practice Address - Phone:804-541-7894
Practice Address - Fax:804-541-7895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health