Provider Demographics
NPI:1265775241
Name:YOUTH FOR TOMORROW NEW LIFE CENTER INC
Entity type:Organization
Organization Name:YOUTH FOR TOMORROW NEW LIFE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-396-7234
Mailing Address - Street 1:11835 HAZEL CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:VA
Mailing Address - Zip Code:20136-2180
Mailing Address - Country:US
Mailing Address - Phone:703-368-7995
Mailing Address - Fax:703-361-4335
Practice Address - Street 1:11835 HAZEL CIRCLE DR
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:VA
Practice Address - Zip Code:20136-2180
Practice Address - Country:US
Practice Address - Phone:703-368-7995
Practice Address - Fax:703-361-4335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1953-02-029251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health