MEDICARE: SET GOALS YCDI 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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1568115525
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SET GOALS YCDI LLC,

Provider Business Mailing Address
First Line	:	1907 SIMMONS LN
Second Line	:
City	:	HAMPTON
State	:	GA
Zip	:	30228-5347
Country	:	US
Telephone Number	:	404-514-1197
Fax Number	:

Provider Business Practice Location Address
First Line	:	1907 SIMMONS LN
Second Line	:
City	:	HAMPTON
State	:	GA
Zip	:	30228-5347
Country	:	US
Telephone Number	:	404-514-1197
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. MERRY WATKINS
Credential	:
Telephone Number	:	140-451-4119

Provider Enumeration Date	:	01/31/2022
Last Update Date	:	02/11/2022

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