Healthcare Provider Details

I. General information

NPI: 1467663708
Provider Name (Legal Business Name): YOUNGTOWN HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12207 N 113TH AVE
YOUNGTOWN AZ
85363-1208
US

IV. Provider business mailing address

12207 N 113TH AVE
YOUNGTOWN AZ
85363-1208
US

V. Phone/Fax

Practice location:
  • Phone: 623-977-6532
  • Fax: 623-977-6541
Mailing address:
  • Phone: 623-977-6532
  • Fax: 623-977-6541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: MS. SOON E. BURNAM
Title or Position: TREASURER
Credential:
Phone: 949-540-1249