MEDICARE: YUGU ALFRED YOBO

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251E00000X	Home Health Agency
2	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility
3	320700000X	Physical Disabilities Residential Treatment Facility
4	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
5	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility
6	374U00000X	Home Health Aide
7	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
8	385HR2065X	Child Physical Disabilities Respite Care
9	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1720597644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YUGU ALFRED YOBO

Provider Business Mailing Address
First Line	:	500 FOREST AVE STE 8
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04101-1520
Country	:	US
Telephone Number	:	207-352-8572
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 FOREST AVE STE 8
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04101-1520
Country	:	US
Telephone Number	:	207-352-8572
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2017
Last Update Date	:	07/21/2022

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Directions to “ YUGU ALFRED YOBO ” Practice Location

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