Provider Demographics
NPI:1649601493
Name:YOUNG VISIONARIES YOUTH LEADERSHIP ACADEMY
Entity Type:Organization
Organization Name:YOUNG VISIONARIES YOUTH LEADERSHIP ACADEMY
Other - Org Name:SUCCESSFULLY MOTIVATING AFRICAN AMERICANS THROUGH RESILIENCY TRAINING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-881-3382
Mailing Address - Street 1:1331 KENDALL DR
Mailing Address - Street 2:STE 2
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-4325
Mailing Address - Country:US
Mailing Address - Phone:909-881-3382
Mailing Address - Fax:909-881-3385
Practice Address - Street 1:696 S TIPPECANOE AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-2607
Practice Address - Country:US
Practice Address - Phone:909-723-1695
Practice Address - Fax:909-723-1509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-04
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency