Provider Demographics
NPI:1639581937
Name:COORDINATED YOUTH AND HUMAN SERVICES
Entity Type:Organization
Organization Name:COORDINATED YOUTH AND HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BOBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-876-2383
Mailing Address - Street 1:2016 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-4657
Mailing Address - Country:US
Mailing Address - Phone:618-876-2383
Mailing Address - Fax:618-876-4952
Practice Address - Street 1:2016 MADISON AVE
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-4657
Practice Address - Country:US
Practice Address - Phone:618-876-2383
Practice Address - Fax:618-876-4952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-21
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No251B00000XAgenciesCase Management
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care