Provider Demographics
NPI:1861687899
Name:THE AGENCY FOR YOUTH AND FAMILY DEVELOPMENT
Entity Type:Organization
Organization Name:THE AGENCY FOR YOUTH AND FAMILY DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:THD
Authorized Official - Phone:901-387-5840
Mailing Address - Street 1:1071 MULLINS STATION RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-7723
Mailing Address - Country:US
Mailing Address - Phone:901-387-5840
Mailing Address - Fax:901-387-5739
Practice Address - Street 1:1071 MULLINS STATION RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-7723
Practice Address - Country:US
Practice Address - Phone:901-387-5840
Practice Address - Fax:901-387-5739
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE AGENCY FOR YOUTH AND FAMILY DEVELOPMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL237M30176449322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children