Provider Demographics
NPI:1205078748
Name:YOUTH OPPORTUNITIES, INC.
Entity type:Organization
Organization Name:YOUTH OPPORTUNITIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE & BUSINESS
Authorized Official - Prefix:MR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:MARIANO
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:MA
Authorized Official - Phone:336-724-1412
Mailing Address - Street 1:206 N. SPRUCE ST.
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-2736
Mailing Address - Country:US
Mailing Address - Phone:336-724-1412
Mailing Address - Fax:336-724-1464
Practice Address - Street 1:1401 W CLEMMONSVILLE RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-5915
Practice Address - Country:US
Practice Address - Phone:336-724-1412
Practice Address - Fax:336-724-1464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-034-214251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health