Provider Demographics
NPI:1750522967
Name:THE YOUTH LIGHT FOUNDATION, INC
Entity type:Organization
Organization Name:THE YOUTH LIGHT FOUNDATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-567-0700
Mailing Address - Street 1:PO BOX 1655
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06759-1655
Mailing Address - Country:US
Mailing Address - Phone:860-567-0700
Mailing Address - Fax:860-567-5901
Practice Address - Street 1:3 WEST ST
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:CT
Practice Address - Zip Code:06759-3501
Practice Address - Country:US
Practice Address - Phone:860-567-0700
Practice Address - Fax:860-567-5901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000701251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management