MEDICARE: YAHWEH HEALING MINDS COMMUNITY CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1033089719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YAHWEH HEALING MINDS COMMUNITY CARE LLC

Provider Business Mailing Address
First Line	:	5580 ANGEL OAKS DR
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27105-9112
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5580 ANGEL OAKS DR
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27105-9112
Country	:	US
Telephone Number	:	929-351-7288
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	EBONY MALDONADO
Credential	:
Telephone Number	:	929-351-7288

Provider Enumeration Date	:	11/07/2025
Last Update Date	:	11/07/2025

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