Healthcare Provider Details

I. General information

NPI: 1871347385
Provider Name (Legal Business Name): YMOA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2024
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 W COLISEUM BLVD STE G
FORT WAYNE IN
46808-1291
US

IV. Provider business mailing address

9823 EBYWOOD LN
FORT WAYNE IN
46835-9742
US

V. Phone/Fax

Practice location:
  • Phone: 571-298-7618
  • Fax:
Mailing address:
  • Phone: 571-298-7618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MRS. TASHA NICOLE DAVIS
Title or Position: FOUNDER / CEO
Credential: DOULA
Phone: 571-298-7618