Provider Demographics
NPI:1821394610
Name:YOUTH STARS
Entity Type:Organization
Organization Name:YOUTH STARS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAVON
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLIARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-617-7908
Mailing Address - Street 1:102 TEAKWOOD DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-8185
Mailing Address - Country:US
Mailing Address - Phone:336-617-7908
Mailing Address - Fax:
Practice Address - Street 1:102 TEAKWOOD DR
Practice Address - Street 2:SUITE F
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-8185
Practice Address - Country:US
Practice Address - Phone:336-617-7908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-27
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle