YOUTH PROFILE INC. NPI 1023171758

NPI Information

  • NPI: 1023171758
  • Provider Name: YOUTH PROFILE INC.
  • Classification: Residential Treatment Facility, Emotionally Disturbed Children - 322D00000X
  • Entity Type: Organization
  • Other Name: EASTSIDE PLACE
  • Address: 4010 COLTRAIN RD
    GREENSBORO, NC
    ZIP 27455
  • Phone: (336) 545-1612

Map and Directions

Get Directions

NPI Details

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
1322D00000XResidential Treatment Facility, Emotionally Disturbed ChildrenMHL-041-204NORTH CAROLINAYes

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
16603100MEDICAIDNORTH 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: 11/21/2025

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

Previous NPI
Next NPI