Healthcare Provider Details

I. General information

NPI: 1831302108
Provider Name (Legal Business Name): YOUNG HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 N ITHACA AVE
RUSSELLVILLE AR
72801-4301
US

IV. Provider business mailing address

PO DRAWER 2109
RUSSELLVILLE AR
72811
US

V. Phone/Fax

Practice location:
  • Phone: 479-967-2322
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number444
License Number StateAR

VIII. Authorized Official

Name: CINDY MAHAN
Title or Position: CEO
Credential:
Phone: 479-967-2322