Provider Demographics
NPI:1295561850
Name:MAN TO MAN - URBAN YOUTH ADVOCATE INC
Entity type:Organization
Organization Name:MAN TO MAN - URBAN YOUTH ADVOCATE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEWART
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRILLIAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-750-4334
Mailing Address - Street 1:5416 SHALLOWS PL W
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-5502
Mailing Address - Country:US
Mailing Address - Phone:408-750-4334
Mailing Address - Fax:
Practice Address - Street 1:7200 BANCROFT AVE STE 266
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2465
Practice Address - Country:US
Practice Address - Phone:408-750-4334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251V00000XAgenciesVoluntary or CharitableGroup - Multi-Specialty
No177F00000XOther Service ProvidersLodging
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty