NPIMap

Organization Active NPI

Youth Opportunities

  • Community/Behavioral Health Agency
  • Kernersville, NC
National Provider Identifier
1083917884
Registry record updated May 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
YOUTH OPPORTUNITIES
Practice address
810 Bagley Road
Kernersville, NC 27284-9897
Phone
(336) 724-1412
Fax
(336) 724-1464
NPI assigned
Dec 16, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2012

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

Authorized official

Name
Mr. Manuel Mariano Gomez
Title
V.P. Finance and Business
Phone
(336) 724-1412

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X NC
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

810 Bagley Road
Kernersville, NC 27284-9897

Mailing address

7670 Northpoint CT.
Wisnton-Salem, NC 27106-3336
Phone (336) 724-1412

Other identifiers 1

IdentifierTypeStateIssuer
8303449RMedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Youth Opportunities Inc9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

810 Bagley Rd
Kernersville, NC 27284
Phone (336) 703-6765

NPI Registry JSON

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

{
    "created_epoch": "1292457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337126400000",
    "number": "1083917884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7670 NORTHPOINT CT.",
            "city": "WISNTON-SALEM",
            "state": "NC",
            "postal_code": "271063336",
            "telephone_number": "336-724-1412",
            "fax_number": "336-724-1464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 BAGLEY ROAD",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272849897",
            "telephone_number": "336-724-1412",
            "fax_number": "336-724-1464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOUTH OPPORTUNITIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-16",
        "last_updated": "2012-05-16",
        "status": "A",
        "authorized_official_last_name": "GOMEZ",
        "authorized_official_first_name": "MANUEL",
        "authorized_official_middle_name": "MARIANO",
        "authorized_official_title_or_position": "V.P. FINANCE AND BUSINESS",
        "authorized_official_telephone_number": "336-724-1412",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8303449R",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kernersville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2012; 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.