Healthcare Provider Details

I. General information

NPI: 1962055657
Provider Name (Legal Business Name): YOUNGS HEALTHCARE SENIOR CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4215 EVERGREEN LN
ANNANDALE VA
22003-3210
US

IV. Provider business mailing address

4215 EVERGREEN LN
ANNANDALE VA
22003-3210
US

V. Phone/Fax

Practice location:
  • Phone: 703-649-4271
  • Fax:
Mailing address:
  • Phone: 703-649-4271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: YOUNG SHIN LEE
Title or Position: PRESIDENT
Credential:
Phone: 703-649-4271