Provider Demographics
NPI:1336562677
Name:HENRY AND RILLA WHITE YOUTH FOUNDATION, INC.
Entity Type:Organization
Organization Name:HENRY AND RILLA WHITE YOUTH FOUNDATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TARGETED CASE MANAGEMENT SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JUSTIN
Authorized Official - Last Name:ANTHONY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-752-7813
Mailing Address - Street 1:1531 SW COMMERCIAL GLN
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-0454
Mailing Address - Country:US
Mailing Address - Phone:386-752-7813
Mailing Address - Fax:386-752-7836
Practice Address - Street 1:1531 SW COMMERCIAL GLN
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-0454
Practice Address - Country:US
Practice Address - Phone:386-752-7813
Practice Address - Fax:386-752-7836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management