Provider Demographics
NPI:1629287404
Name:DIABETES YOUTH SERVICES
Entity Type:Organization
Organization Name:DIABETES YOUTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONDON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, CDE
Authorized Official - Phone:419-480-1796
Mailing Address - Street 1:4143 MONROE ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-2065
Mailing Address - Country:US
Mailing Address - Phone:419-480-1796
Mailing Address - Fax:419-480-1794
Practice Address - Street 1:4143 MONROE ST
Practice Address - Street 2:SUITE 10
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-2065
Practice Address - Country:US
Practice Address - Phone:419-480-1796
Practice Address - Fax:419-480-1794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable