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General NPI Number Information
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NPI Number | 1205570942
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Entity Type | Organization
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Legal Business Name | YOUNG 60 PLUS CLUB LLC.
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Dates
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Enumeration Date | 04/27/2022
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Last Update Date | 12/29/2023
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Provider Practice Location Address
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Address Line | 4437 LINCOLN HWY
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City | MATTESON
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State | IL
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Zip | 60443-2317
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Country | US
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Telephone | 833-960-7587
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Fax | 309-882-0065
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Provider Business Mailing Address
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Address Line | 4437 LINCOLN HWY
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City | MATTESON
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State | IL
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Zip | 60443-2317
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Country | US
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Telephone | 833-960-7587
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Fax | 309-882-0065
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Authorized Official
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Title or Position | CEO
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Name | BRITTNEY M JETER
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Credential | LPN, IPN, MA,
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Telephone | 833-960-7587
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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