Provider Demographics
NPI:1902370109
Name:YOUTH FOR TOMORROW NEW LIFE CENTER, INC.
Entity Type:Organization
Organization Name:YOUTH FOR TOMORROW NEW LIFE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-636-5100
Mailing Address - Street 1:11835 HAZEL CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:VA
Mailing Address - Zip Code:20136-2180
Mailing Address - Country:US
Mailing Address - Phone:703-636-5100
Mailing Address - Fax:703-361-4335
Practice Address - Street 1:11835 HAZEL CIRCLE DR
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:VA
Practice Address - Zip Code:20136-2180
Practice Address - Country:US
Practice Address - Phone:703-636-5100
Practice Address - Fax:703-361-4335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1316118292Medicaid