Provider Demographics
NPI:1174163844
Name:NEIGHBORHOOD MENTORING ACADEMY INC.
Entity type:Organization
Organization Name:NEIGHBORHOOD MENTORING ACADEMY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FLETCHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:UPSHAW
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:260-615-0153
Mailing Address - Street 1:916 E HAWTHORNE ST
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46806-3144
Mailing Address - Country:US
Mailing Address - Phone:260-615-0153
Mailing Address - Fax:
Practice Address - Street 1:916 E HAWTHORNE ST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46806-3144
Practice Address - Country:US
Practice Address - Phone:260-615-0153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health