Provider Demographics
NPI:1699836072
Name:FAMILY YOUTHWORKS, INC.
Entity Type:Organization
Organization Name:FAMILY YOUTHWORKS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTIONST
Authorized Official - Prefix:MS
Authorized Official - First Name:CORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-803-8180
Mailing Address - Street 1:2205 ERIE AVE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-3734
Mailing Address - Country:US
Mailing Address - Phone:920-803-8180
Mailing Address - Fax:920-803-8387
Practice Address - Street 1:2205 ERIE AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3734
Practice Address - Country:US
Practice Address - Phone:920-803-8180
Practice Address - Fax:920-803-8387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty