Provider Demographics
NPI:1356547533
Name:GLOBAL YOUTH SERVICES BOWLING GREEN
Entity type:Organization
Organization Name:GLOBAL YOUTH SERVICES BOWLING GREEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:GALLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-860-1035
Mailing Address - Street 1:2953 WILSON RD
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-4364
Mailing Address - Country:US
Mailing Address - Phone:813-949-8698
Mailing Address - Fax:813-909-8476
Practice Address - Street 1:2953 WILSON RD
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-4364
Practice Address - Country:US
Practice Address - Phone:813-949-8698
Practice Address - Fax:813-909-8476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health