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General NPI Number Information
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NPI Number | 1518723535
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Entity Type | Organization
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Legal Business Name | YOUNG HEARTS EXTENDED ASSISTED LIVING FACILITY, LLC
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Dates
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Enumeration Date | 02/27/2024
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Last Update Date | 02/27/2024
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Provider Practice Location Address
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Address Line | 329 N CHURCH ST
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City | STARKE
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State | FL
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Zip | 32091-3434
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Country | US
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Telephone | 904-769-1122
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Fax | 206-844-9037
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Provider Business Mailing Address
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Address Line | 1410 NE 219TH ST
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City | LAWTEY
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State | FL
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Zip | 32058-4387
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Country | US
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Telephone | 904-769-1122
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Fax | 206-844-9037
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. NIKITA L JENKINS
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Credential | RN
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Telephone | 904-769-1122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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