Provider Demographics
NPI:1720392764
Name:YOUTH HOPE INC.
Entity Type:Organization
Organization Name:YOUTH HOPE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:B
Authorized Official - Last Name:IBEABUCHI
Authorized Official - Suffix:
Authorized Official - Credentials:PH D, LCSW
Authorized Official - Phone:909-884-3415
Mailing Address - Street 1:577 N D ST
Mailing Address - Street 2:STE 100
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92401-1324
Mailing Address - Country:US
Mailing Address - Phone:909-884-3415
Mailing Address - Fax:909-884-3417
Practice Address - Street 1:577 N D ST
Practice Address - Street 2:STE 100
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401-1324
Practice Address - Country:US
Practice Address - Phone:909-884-3415
Practice Address - Fax:909-884-3417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 183571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty