Provider Demographics
NPI:1790830172
Name:YOUNGSTOWN URBAN MINORITY ALCOHOLISM AND DRUG ABUSE OUTREACH PROG INC
Entity Type:Organization
Organization Name:YOUNGSTOWN URBAN MINORITY ALCOHOLISM AND DRUG ABUSE OUTREACH PROG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:G
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:330-743-2772
Mailing Address - Street 1:496 GLENWOOD AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44502-1509
Mailing Address - Country:US
Mailing Address - Phone:330-743-2772
Mailing Address - Fax:330-743-2238
Practice Address - Street 1:496 GLENWOOD AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44502-1509
Practice Address - Country:US
Practice Address - Phone:330-743-2772
Practice Address - Fax:330-743-2238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1117OtherDRUG & ALCOHOL PREVENTION