Southside Youth Council, Inc

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

SOUTHSIDE YOUTH COUNCIL, INC

Doing business as

Reach For Youth, Inc

Practice address

5401 Shelby St
Indianapolis, IN 46227-4216

Phone

(317) 788-4451

Fax

(317) 788-4465

NPI assigned

Nov 2, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Christopher Nunn

Title

President, Executive Director

Phone

(317) 920-5900

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Reach For Youth, Inc Doing business as

Tax ID family

Reach for Youth Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Reach for Youth

  • Case Management Agency
  • Indianapolis, IN
  • NPI 1396070462
  NPD tax ID
• Southside Youth Council

  dba Reach For Youth, Inc.

  • Community/Behavioral Health Agency
  • Indianapolis, IN
  • NPI 1407230451
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Robert B Bennett, DSW, LCSW

  • Clinical Social Worker
  • Indianapolis, IN
  • NPI 1871736033
  NPD (past)
• Thomas Bontrager, MSW

  • Clinical Social Worker
  • Indianapolis, IN
  • NPI 1841315785
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213747200000",
    "number": "1003994245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3505 WASHINGTON BLVD",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462053718",
            "telephone_number": "317-920-5900",
            "fax_number": "317-920-5911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5401 SHELBY ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462274216",
            "telephone_number": "317-788-4451",
            "fax_number": "317-788-4465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE YOUTH COUNCIL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-02",
        "last_updated": "2008-06-18",
        "status": "A",
        "authorized_official_last_name": "NUNN",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "PRESIDENT, EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "317-920-5900"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100071720",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Reach For Youth, Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Southside Internal Medicine PC
• Southside OB-GYN PC
• Southside Pediatrics, Inc.
• Southside Physical Therapy Clinic
• Southside Youth Council (Reach For Youth, Inc.)
• Lindsey Southwick
• Nathaniel Robert Southwick
• Elizabeth Alexandra Southwood, MSW
• Erin L Southworth, PHARM.D.
• Sovereign Care Home Health LLC

• Community/Behavioral Health Agency in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Community/Behavioral Health Agency in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.