Youthbridge

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

License

171MOOOOOX Issued in AR

Legal business name

YOUTHBRIDGE

Practice address

2153 E Joyce Blvd
Fayettville, AR 72703

Phone

(479) 575-9471

NPI assigned

Jul 22, 2014

Last updated

Jul 22, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Miss Marilyn Hoke

Title

Human Resources

Phone

(479) 575-9471

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1405987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405987200000",
    "number": "1912314972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2153 E JOYCE BLVD",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034714",
            "telephone_number": "479-575-9471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2153 E JOYCE BLVD",
            "city": "FAYETTVILLE",
            "state": "AR",
            "postal_code": "72703",
            "telephone_number": "479-575-9471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOUTHBRIDGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-22",
        "last_updated": "2014-07-22",
        "status": "A",
        "authorized_official_last_name": "HOKE",
        "authorized_official_first_name": "MARILYN",
        "authorized_official_title_or_position": "HUMAN RESOURCES",
        "authorized_official_telephone_number": "479-575-9471",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "AR",
            "license": "171MOOOOOX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2014; 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.