NPIMap

Organization Active NPI

Youth Development Corporation of America

  • Community/Behavioral Health Agency
  • Henderson, NC
National Provider Identifier
1629023569
Registry record updated Aug 10, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
YOUTH DEVELOPMENT CORPORATION OF AMERICA
Practice address
803 S Garnett St
Henderson, NC 27536-4512
Phone
(252) 433-6060
Fax
(252) 433-6464
NPI assigned
May 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2010

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

Authorized official

Name
Brelyn Waddell
Title
Billing Specialist Supervisor
Phone
(919) 323-8090

Specialties & licenses 1

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

Addresses

Primary practice location

803 S Garnett St
Henderson, NC 27536-4512

Mailing address

5611 NC Highway 55
Suite 101
Durham, NC 27713-4395

Other identifiers 3

IdentifierTypeStateIssuer
5901996MedicaidNC
6005421MedicaidNC
8300409MedicaidNC

Other names 1

  • Caring Family Network Doing business as

National Provider Directory

National Provider Directory

Locations

1214 Vaughn Rd
Lowr
Burlington, NC 27217
Phone (336) 227-5050

1415 W NC Highway 54
Bldg 100
Durham, NC 27707

5850 Fayetteville Rd
Ste 203
Durham, NC 27713

5720 Fayetteville Rd
Durham, NC 27713
Phone (919) 484-8198

803 S Garnett St
Henderson, NC 27536
Phone (252) 433-6060

125 Charles Rollins Rd
Henderson, NC 27536
Phone (252) 430-1330

40 Camp Dr
Pittsboro, NC 27312
Phone (919) 542-4422

Practitioners & affiliated clinicians

Practitioners 29

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1148256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281398400000",
    "number": "1629023569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5611 NC HIGHWAY 55",
            "address_2": "SUITE 101",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277134395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 S GARNETT ST",
            "city": "HENDERSON",
            "state": "NC",
            "postal_code": "275364512",
            "telephone_number": "252-433-6060",
            "fax_number": "252-433-6464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOUTH DEVELOPMENT CORPORATION OF AMERICA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-22",
        "last_updated": "2010-08-10",
        "status": "A",
        "authorized_official_last_name": "WADDELL",
        "authorized_official_first_name": "BRELYN",
        "authorized_official_title_or_position": "BILLING SPECIALIST SUPERVISOR",
        "authorized_official_telephone_number": "919-323-8090"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5901996",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6005421",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300409",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Caring Family Network",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Henderson, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2010; 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.