Provider Demographics
NPI:1790001600
Name:YOUTH SERVICES NETWORK
Entity Type:Organization
Organization Name:YOUTH SERVICES NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:COMMARE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:815-986-1947
Mailing Address - Street 1:107 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-4010
Mailing Address - Country:US
Mailing Address - Phone:815-986-1947
Mailing Address - Fax:815-986-1954
Practice Address - Street 1:107 N 3RD ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-4010
Practice Address - Country:US
Practice Address - Phone:815-986-1947
Practice Address - Fax:815-986-1954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-16
Last Update Date:2015-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL305692-06251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management