NPIMap

Organization Active NPI

Youth for Tomorrow New Life Center, Inc.

  • Community Health Clinic/Center
  • Bristow, VA
National Provider Identifier
1902370109
Registry record updated Jan 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
YOUTH FOR TOMORROW NEW LIFE CENTER, INC.
Practice address
11835 Hazel Circle Dr
Bristow, VA 20136-2180
Phone
(703) 636-5100
Fax
(703) 361-4335
NPI assigned
Jan 22, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2019

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

Authorized official

Name
Lori Perez
Title
Controller
Phone
(703) 636-5100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X Primary

Addresses

Primary practice location

11835 Hazel Circle Dr
Bristow, VA 20136-2180

Mailing address

11835 Hazel Circle Dr
Bristow, VA 20136-2180
Phone (703) 636-5100

Other identifiers 1

IdentifierTypeStateIssuer
1316118292MedicaidVA

National Provider Directory

National Provider Directory
Tax ID family
Youth for Tomorrow New Life Center 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.

NPI Registry JSON

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

{
    "created_epoch": "1548115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548115200000",
    "number": "1902370109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11835 HAZEL CIRCLE DR",
            "city": "BRISTOW",
            "state": "VA",
            "postal_code": "201362180",
            "telephone_number": "703-636-5100",
            "fax_number": "703-361-4335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11835 HAZEL CIRCLE DR",
            "city": "BRISTOW",
            "state": "VA",
            "postal_code": "201362180",
            "telephone_number": "703-636-5100",
            "fax_number": "703-361-4335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOUTH FOR TOMORROW NEW LIFE CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-22",
        "last_updated": "2019-01-22",
        "status": "A",
        "authorized_official_last_name": "PEREZ",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "703-636-5100"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1316118292",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bristow, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2019; 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.