Provider Demographics
NPI:1790018067
Name:YOUTH ORGANIZATIONS UMBRELLA
Entity Type:Organization
Organization Name:YOUTH ORGANIZATIONS UMBRELLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-866-1200
Mailing Address - Street 1:1027 SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-6500
Mailing Address - Country:US
Mailing Address - Phone:847-866-1200
Mailing Address - Fax:847-866-9143
Practice Address - Street 1:1027 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-6500
Practice Address - Country:US
Practice Address - Phone:847-866-1200
Practice Address - Fax:847-866-9143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060673-10261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)