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Organization

UPSIDE TO YOUTH DEVELOPMENT, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. ROBERT E. GAY JR. (CHIEF FINANCIAL OFFICER)
(804) 541-7894
Entity
Organization

Contact information

Practice address
943 STARLING AVE, MARTINSVILLE, VA 24112-6405
(804) 590-4453
Mailing address
943 STARLING AVE, MARTINSVILLE, VA 24112-6405
(804) 590-4453

Taxonomy

Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
1082-05-001
VA

Other

Enumeration date
12/08/2009
Last updated
12/08/2009
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