Provider Demographics
NPI:1972043248
Name:YOUNGSTOWN URBAN MINORITY ALCOHOLISM AND DRUG ABUSE OUTREACH PROGRAM
Entity Type:Organization
Organization Name:YOUNGSTOWN URBAN MINORITY ALCOHOLISM AND DRUG ABUSE OUTREACH PROGRAM
Other - Org Name:YUMADAOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:SR
Authorized Official - Credentials:OCPS II
Authorized Official - Phone:330-743-2772
Mailing Address - Street 1:1327 FLORENCEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-2719
Mailing Address - Country:US
Mailing Address - Phone:330-743-2772
Mailing Address - Fax:330-743-2238
Practice Address - Street 1:1327 FLORENCEDALE AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-2719
Practice Address - Country:US
Practice Address - Phone:330-743-2772
Practice Address - Fax:330-743-2238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1117251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare