NPIMap

Organization Active NPI

Youth Profile, Inc.

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Greensboro, NC
National Provider Identifier
1184787269
Registry record updated Jun 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
MHL-041-637 Issued in NC
Legal business name
YOUTH PROFILE, INC.
Practice address
3520 Drawbridge Pkwy
Apt. D
Greensboro, NC 27410-9621
Phone
(336) 707-0377
Fax
(336) 644-1423
NPI assigned
Dec 19, 2006
Last updated
Jun 13, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2008

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

Authorized official

Name
Mr. Alfred Lee McBride, M.ED.
Title
Asso. Executive Director
Phone
(336) 707-0377

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X MHL-041-637 NC Primary

Addresses

Primary practice location

3520 Drawbridge Pkwy
Apt. D
Greensboro, NC 27410-9621

Mailing address

5683 Greendale CT
Summerfield, NC 27358-9156
Phone (336) 707-0377

Other names 1

  • Linfred Place Other name

National Provider Directory

National Provider Directory
Tax ID family
Eastside Place3 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.

NPI Registry JSON

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213315200000",
    "number": "1184787269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5683 GREENDALE CT",
            "city": "SUMMERFIELD",
            "state": "NC",
            "postal_code": "273589156",
            "telephone_number": "336-707-0377",
            "fax_number": "336-644-1423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3520 DRAWBRIDGE PKWY",
            "address_2": "APT. D",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274109621",
            "telephone_number": "336-707-0377",
            "fax_number": "336-644-1423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOUTH PROFILE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-19",
        "last_updated": "2008-06-13",
        "status": "A",
        "authorized_official_last_name": "MCBRIDE",
        "authorized_official_first_name": "ALFRED",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "ASSO. EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "336-707-0377",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.ED."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL-041-637",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Linfred Place",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Greensboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 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.