Healthcare Provider Details

I. General information

NPI: 1710757208
Provider Name (Legal Business Name): YOUNIVERSAL RESIDENTIAL CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 LIVE OAK DR STE 27
CHESAPEAKE VA
23320-2600
US

IV. Provider business mailing address

809 LIVE OAK DR STE 27
CHESAPEAKE VA
23320-2600
US

V. Phone/Fax

Practice location:
  • Phone: 757-904-1119
  • Fax: 757-299-7836
Mailing address:
  • Phone: 757-904-1119
  • Fax: 757-299-7836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: IESHA ANDREWS
Title or Position: CEO
Credential: RN
Phone: 757-237-1098