MEDICARE: YASMENDA JUSTICE & PEER SUPPORT SERVICES 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	251S00000X	Community/Behavioral Health Agency
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1215894720
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YASMENDA JUSTICE & PEER SUPPORT SERVICES LLC

Provider Business Mailing Address
First Line	:	714 S FRAZIER ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-2808
Country	:	US
Telephone Number	:	445-888-0703
Fax Number	:

Provider Business Practice Location Address
First Line	:	714 S FRAZIER ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-2808
Country	:	US
Telephone Number	:	445-888-0703
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	YASMENDA LEE SCOTT
Credential	:
Telephone Number	:	445-888-0703

Provider Enumeration Date	:	01/06/2026
Last Update Date	:	01/13/2026

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