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Organization
YOUTH SERVICES NETWORK
Active
Organization
YOUTH SERVICES NETWORK
Active
Other names
CFC #1
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA BUCALO (ADMINISTRATIVE/LICENSING MANAGER)
(815) 986-1947
Entity
Organization
Contact information
Practice address
107 N 3RD ST, ROCKFORD, IL 61107-4010
(815) 986-1947
(815) 986-1954
Mailing address
107 N 3RD ST, ROCKFORD, IL 61107-4010
(815) 986-1947
(815) 986-1954
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3000005
—
IL
Enumeration date
11/15/2019
Last updated
11/15/2019
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