=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851760318
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YTB ENTERPRISE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2015
-----------------------------------------------------
Last Update Date | 12/04/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 610 UPTOWN BLVD SUITE 2000
-----------------------------------------------------
City | CEDAR HILL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75104-3527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-702-9513
-----------------------------------------------------
Fax | 903-803-8086
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 610 UPTOWN BLVD SUITE 2000
-----------------------------------------------------
City | CEDAR HILL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75104-3527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-702-9513
-----------------------------------------------------
Fax | 903-803-8086
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | ANITA TRIMBLE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-702-9513
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------