YOUTH PROFILE INC. NPI 1023171758

NPI Information

NPI: 1023171758
Provider Name: YOUTH PROFILE INC.

Other Name: EASTSIDE PLACE

Classification: Residential Treatment Facility, Emotionally Disturbed Children - 322D00000X
Entity Type: Organization
Address:
4010 COLTRAIN RD
GREENSBORO, NC
ZIP 27455
Phone: (336) 545-1612
Get Directions

YOUTH PROFILE INC. is a residential treatment facility emotionally disturbed children in Greensboro, NC. The provider is a residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral issues, and intellectual disabilities and are not able to live independently. YOUTH PROFILE INC. NPI is 1023171758. The provider is registered as an organization entity type.
The provider Other Name Is Eastside Place.

The provider's business location address is:

4010 COLTRAIN RD
GREENSBORO, NC
ZIP 27455-632
Phone: (336) 545-1612
Fax: (336) 644-1423

The provider's authorized official is Alfred Lee Mcbride .
The authorized official title is Asso. Executive Director and has the following contact phone number (336) 707-0377.

The enumeration date for this NPI number is 12/16/2006 and was last updated on 6/13/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	322D00000X	Residential Treatment Facility, Emotionally Disturbed Children		MHL-041-204	NORTH CAROLINA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	6603100	MEDICAID	NORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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