Eastside Place

LBN: Youth Profile Inc.
Eastside Place is an health care organization with primary practice located at 4010 Coltrain Rd , Greensboro NC 27455-2632. The organization recently has only one registered license in Residential Treatment Facilities / Residential Treatment Facility, Emotionally Disturbed Children, which is considered as the primary health care specialty. Youth Profile Inc. can be contacted via phone (336) 545-1612, or through Mcbride, Alfred Lee via phone (336) 707-0377.

Contact Information

Primary practice address
4010 Coltrain Rd Greensboro NC 27455-2632
Phone: (336) 545-1612
Fax: (336) 644-1423
Website:
Map and Directions
Authorized official contact:
Name: Mcbride, Alfred Lee Master of Education (MED)
Phone: (336) 707-0377

Health care specialties

SpecialtyCodeLicense #State
Residential Treatment Facilities / Residential Treatment Facility, Emotionally Disturbed Children 322D00000X MHL-041-204 North Carolina

Profile Details

NPI number 1023171758
LBN Legal business name Youth Profile Inc.
DBA Doing business as Eastside Place
Authorized official Mcbride, Alfred Lee Master of Education (MED)
Entity Organization
Organization subpart 1 No
Enumeration date Dec 16th, 2006
Last updated Jun 13th, 2008 - about 16 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1023171758 NPPES
North Carolina MEDICAID 6603100

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