Provider Demographics
NPI:1255921698
Name:BOYS OF SUSTAINABLE STRENGTH MENTORING, INC.
Entity type:Organization
Organization Name:BOYS OF SUSTAINABLE STRENGTH MENTORING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YANIECE
Authorized Official - Middle Name:SHARAE
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:BSW, MS
Authorized Official - Phone:609-707-4726
Mailing Address - Street 1:1440 HADDON AVE
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-3111
Mailing Address - Country:US
Mailing Address - Phone:609-707-4726
Mailing Address - Fax:
Practice Address - Street 1:1030 S 5TH ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-2038
Practice Address - Country:US
Practice Address - Phone:856-295-2584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251300000XAgenciesLocal Education Agency (LEA)
No251B00000XAgenciesCase Management
No251V00000XAgenciesVoluntary or Charitable