Provider Demographics
NPI:1992024061
Name:YOUTH FOCUS
Entity Type:Organization
Organization Name:YOUTH FOCUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:HODIERNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-274-5909
Mailing Address - Street 1:715 N EUGENE ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1621
Mailing Address - Country:US
Mailing Address - Phone:336-274-5909
Mailing Address - Fax:336-274-3622
Practice Address - Street 1:713 N CENTENNIAL ST
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4215
Practice Address - Country:US
Practice Address - Phone:336-882-1662
Practice Address - Fax:336-274-3622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF03049251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCF03049OtherSTATE DSS