Organization Active NPI

Youth Development Services, LLC

  • Community/Behavioral Health Agency
  • Hackensack, NJ
National Provider Identifier
1134327679
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
YOUTH DEVELOPMENT SERVICES, LLC
Practice address
271 Standish Ave
Hackensack, NJ 07601-1716
Phone
(201) 543-3935
NPI assigned
Jul 5, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Tara J Spates
Title
Authorized Member
Phone
(912) 389-1205

Specialties & licenses 1

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

Addresses

Primary practice location

271 Standish Ave
Hackensack, NJ 07601-1716

Mailing address

6658 Sinkhole Rd
Ambrose, GA 31512-3890
Phone (912) 389-1205

Other identifiers 1

IdentifierTypeStateIssuer
0036587MedicaidNJ

National Provider Directory

National Provider Directory
Tax ID family
Youth Development Services LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

NPI Registry JSON

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

{
    "created_epoch": "1183593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1134327679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6658 SINKHOLE RD",
            "city": "AMBROSE",
            "state": "GA",
            "postal_code": "315123890",
            "telephone_number": "912-389-1205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "271 STANDISH AVE",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076011716",
            "telephone_number": "201-543-3935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOUTH DEVELOPMENT SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SPATES",
        "authorized_official_first_name": "TARA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "AUTHORIZED MEMBER",
        "authorized_official_telephone_number": "912-389-1205"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NJ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0036587",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hackensack, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.