MEDICARE: YANCEY'S FACILITATION, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467835264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YANCEY'S FACILITATION, LLC

Provider Business Mailing Address
First Line	:	5019 HICKORY RD
Second Line	:
City	:	SOUTH CHESTERFIELD
State	:	VA
Zip	:	23803-1523
Country	:	US
Telephone Number	:	804-931-4864
Fax Number	:	804-524-0480

Provider Business Practice Location Address
First Line	:	5019 HICKORY RD
Second Line	:
City	:	SOUTH CHESTERFIELD
State	:	VA
Zip	:	23803-1523
Country	:	US
Telephone Number	:	804-931-4864
Fax Number	:	804-524-0480

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. GRACE YANCEY
Credential	:	RN
Telephone Number	:	804-931-4864

Provider Enumeration Date	:	06/30/2015
Last Update Date	:	06/30/2015

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