Provider Demographics
NPI:1821593054
Name:YP RTP
Entity Type:Organization
Organization Name:YP RTP
Other - Org Name:YOUTH PROMOTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-907-1760
Mailing Address - Street 1:4819 EMPEROR BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-5420
Mailing Address - Country:US
Mailing Address - Phone:877-511-7912
Mailing Address - Fax:
Practice Address - Street 1:4819 EMPEROR BLVD STE 400
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-5420
Practice Address - Country:US
Practice Address - Phone:877-511-7912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health