MEDICARE: YOUTHFUL AGING HEALTHCARE SERVICES 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	174200000X	Meals Provider
2	251C00000X	Developmentally Disabled Services Day Training Agency
3	251E00000X	Home Health Agency		FL
4	251E00000X	Home Health Agency
5	251G00000X	Community Based Hospice Care Agency
6	251J00000X	Nursing Care Agency
7	253Z00000X	In Home Supportive Care Agency
8	310400000X	Assisted Living Facility
9	3104A0625X	Assisted Living Facility (Mental Illness)
10	311ZA0620X	Adult Care Home Facility
11	332U00000X	Home Delivered Meals
12	343900000X	Non-emergency Medical Transport (VAN)
13	347C00000X	Private Vehicle
14	385H00000X	Respite Care
15	164W00000X	Licensed Practical Nurse	PN5182304	FL

General Provider Information

NPI Number	:	1760970347
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUTHFUL AGING HEALTHCARE SERVICES LLC.

Provider Business Mailing Address
First Line	:	2307 MONDAY RD
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32301-6115
Country	:	US
Telephone Number	:	850-815-0660
Fax Number	:

Provider Business Practice Location Address
First Line	:	2307 MONDAY RD
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32301-6115
Country	:	US
Telephone Number	:	850-815-0660
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	KEEMASHEKA JONES
Credential	:
Telephone Number	:	850-815-0660

Provider Enumeration Date	:	04/29/2018
Last Update Date	:	04/29/2018

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