Provider Demographics
NPI:1851673230
Name:NU-START YOUTH INTERVENTION SERVICES LLC
Entity Type:Organization
Organization Name:NU-START YOUTH INTERVENTION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:DONNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW-CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-421-4130
Mailing Address - Street 1:5039 BACKLICK RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-6046
Mailing Address - Country:US
Mailing Address - Phone:703-750-1132
Mailing Address - Fax:703-750-1142
Practice Address - Street 1:5039 BACKLICK RD
Practice Address - Street 2:SUITE A
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-6046
Practice Address - Country:US
Practice Address - Phone:703-750-1132
Practice Address - Fax:703-750-1142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children