Provider Demographics
NPI:1790749596
Name:YOUTH FORUM INC
Entity Type:Organization
Organization Name:YOUTH FORUM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPA
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUZAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-760-8602
Mailing Address - Street 1:PO BOX 341097
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43234-1097
Mailing Address - Country:US
Mailing Address - Phone:614-891-2703
Mailing Address - Fax:
Practice Address - Street 1:40 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-2204
Practice Address - Country:US
Practice Address - Phone:614-891-2703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare