Provider Demographics
NPI:1871007062
Name:NATIONAL YOUTH ADVOCATE PROGRAM, INC
Entity Type:Organization
Organization Name:NATIONAL YOUTH ADVOCATE PROGRAM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARVENA
Authorized Official - Middle Name:
Authorized Official - Last Name:TWIGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-202-2965
Mailing Address - Street 1:1801 WATERMARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-7088
Mailing Address - Country:US
Mailing Address - Phone:888-202-2965
Mailing Address - Fax:614-487-8759
Practice Address - Street 1:2200 ROSSELLE ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-3126
Practice Address - Country:US
Practice Address - Phone:904-551-2399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-27
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1871007062Medicaid