Organization
YOUTH PROFILE INC.
Active
Other names
Eastside Place
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALFRED LEE MCBRIDE M.ED (ASSO. EXECUTIVE DIRECTOR)
(336) 707-0377
Entity
Organization
Contact information
Practice address
4010 COLTRAIN RD, GREENSBORO, NC 27455-2632
(336) 545-1612
(336) 644-1423
Mailing address
5683 GREENDALE CT, SUMMERFIELD, NC 27358-9156
(336) 707-0377
(336) 644-1423
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL-041-204
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6603100
—
NC
Enumeration date
12/16/2006
Last updated
06/13/2008
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