Provider Demographics
NPI:1023720851
Name:CBRS YOUTH LLC
Entity type:Organization
Organization Name:CBRS YOUTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-207-0171
Mailing Address - Street 1:4615 W GATE CITY BLVD # 7147
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-4239
Mailing Address - Country:US
Mailing Address - Phone:336-207-0171
Mailing Address - Fax:
Practice Address - Street 1:4615 W GATE CITY BLVD # 7147
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-4239
Practice Address - Country:US
Practice Address - Phone:336-207-0171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-26
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No347C00000XTransportation ServicesPrivate Vehicle
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC193200000XMedicaid
NC405300000XMedicaid