Provider Demographics
NPI:1669709515
Name:YOUTH INTERACTIVE PREVENTION SERVICES INC
Entity type:Organization
Organization Name:YOUTH INTERACTIVE PREVENTION SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRISHA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BORRESEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-324-6885
Mailing Address - Street 1:152 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JEROME
Mailing Address - State:ID
Mailing Address - Zip Code:83338-2333
Mailing Address - Country:US
Mailing Address - Phone:208-324-6885
Mailing Address - Fax:
Practice Address - Street 1:152 E MAIN ST
Practice Address - Street 2:
Practice Address - City:JEROME
Practice Address - State:ID
Practice Address - Zip Code:83338-2333
Practice Address - Country:US
Practice Address - Phone:208-324-6885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health