Organization
YOUTH FOR TOMORROW NEW LIFE CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI PEREZ (CONTROLLER)
(703) 636-5100
Entity
Organization
Contact information
Practice address
11835 HAZEL CIRCLE DR, BRISTOW, VA 20136-2180
(703) 636-5100
(703) 361-4335
Mailing address
11835 HAZEL CIRCLE DR, BRISTOW, VA 20136-2180
(703) 636-5100
(703) 361-4335
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316118292
—
VA
Enumeration date
01/22/2019
Last updated
01/22/2019
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