Provider Demographics
NPI:1760655310
Name:CREATIVE YOUTH CONCEPTS INC.
Entity Type:Organization
Organization Name:CREATIVE YOUTH CONCEPTS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:QUO VADIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-525-4101
Mailing Address - Street 1:2007 BROOK RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-1807
Mailing Address - Country:US
Mailing Address - Phone:804-525-4101
Mailing Address - Fax:804-525-4102
Practice Address - Street 1:2007 BROOK RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-1807
Practice Address - Country:US
Practice Address - Phone:804-525-4101
Practice Address - Fax:804-525-4102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-03
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health