Healthcare Provider Details

I. General information

NPI: 1801572920
Provider Name (Legal Business Name): YOUNG VISIONS HOME CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 N 5TH STREET
MILWAUKEE WI
53212
US

IV. Provider business mailing address

PO BOX 76068
MILWAUKEE WI
53216-7668
US

V. Phone/Fax

Practice location:
  • Phone: 414-914-9339
  • Fax: 414-914-9239
Mailing address:
  • Phone: 414-914-9339
  • Fax: 414-914-9239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health 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 Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. LA SHANDRA NICHELLE YOUNG
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 414-914-9339