Provider Demographics
NPI:1629416003
Name:YOUTH UNLIMITED INC
Entity Type:Organization
Organization Name:YOUTH UNLIMITED INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EX DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:R
Authorized Official - Middle Name:CLIFFORD
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MA LPC
Authorized Official - Phone:336-883-1361
Mailing Address - Street 1:PO BOX 485
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27261-0485
Mailing Address - Country:US
Mailing Address - Phone:336-883-1361
Mailing Address - Fax:336-883-0065
Practice Address - Street 1:2872 YOUTH UNLIMITED DR
Practice Address - Street 2:
Practice Address - City:SOPHIA
Practice Address - State:NC
Practice Address - Zip Code:27350-8460
Practice Address - Country:US
Practice Address - Phone:336-861-1413
Practice Address - Fax:336-861-9253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-07
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603220Medicaid