Provider Demographics
NPI:1245847664
Name:YOUNG LIFE AL INC.
Entity type:Organization
Organization Name:YOUNG LIFE AL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IONUT
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-561-1285
Mailing Address - Street 1:1518 W ORANGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-7950
Mailing Address - Country:US
Mailing Address - Phone:602-561-1285
Mailing Address - Fax:
Practice Address - Street 1:2334 W RANCHO DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2211
Practice Address - Country:US
Practice Address - Phone:602-464-9557
Practice Address - Fax:602-464-9551
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YOUNG LIFE AL INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH-6294OtherDEPARTMENT OF HEALTH SERVICES