Healthcare Provider Details

I. General information

NPI: 1982968301
Provider Name (Legal Business Name): YOUR INDEPENDENCE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 01/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1557 VERNON ODOM BLVD 104
AKRON OH
44320-4061
US

IV. Provider business mailing address

1557 VERNON ODOM BLVD 104
AKRON OH
44320-4061
US

V. Phone/Fax

Practice location:
  • Phone: 866-287-4157
  • Fax: 330-983-9494
Mailing address:
  • Phone: 866-287-4157
  • Fax: 330-983-9494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number7706870
License Number StateOH

VIII. Authorized Official

Name: MS. JESSICA K JONES
Title or Position: CEO
Credential:
Phone: 866-287-4157