Provider Demographics
NPI:1982804308
Name:UPSIDE TO YOUTH DEVELOPMENT L.L.C.
Entity Type:Organization
Organization Name:UPSIDE TO YOUTH DEVELOPMENT L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:804-943-0629
Mailing Address - Street 1:9401 COURTHOUSE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-6686
Mailing Address - Country:US
Mailing Address - Phone:804-205-1011
Mailing Address - Fax:804-479-8175
Practice Address - Street 1:9401 COURTHOUSE RD STE 300
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-6686
Practice Address - Country:US
Practice Address - Phone:804-205-1011
Practice Address - Fax:804-479-8175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility