Provider Demographics
NPI:1619399037
Name:YOUTH EDUCATION & SUPPORT INC.
Entity Type:Organization
Organization Name:YOUTH EDUCATION & SUPPORT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSARIO
Authorized Official - Middle Name:C
Authorized Official - Last Name:LANDA
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:305-283-7039
Mailing Address - Street 1:13615 S DIXIE HWY
Mailing Address - Street 2:#109-322
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-7254
Mailing Address - Country:US
Mailing Address - Phone:305-283-7039
Mailing Address - Fax:305-234-7592
Practice Address - Street 1:13615 S DIXIE HWY
Practice Address - Street 2:#109-322
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-7254
Practice Address - Country:US
Practice Address - Phone:305-283-7039
Practice Address - Fax:305-234-7592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL812314400Medicaid