MEDICARE: YOUNG ACHIEVERS ADULT DAY CARE CENTER 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	251E00000X	Home Health Agency
2	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1568238467
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUNG ACHIEVERS ADULT DAY CARE CENTER LLC

Provider Business Mailing Address
First Line	:	7315 DETROIT AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-3030
Country	:	US
Telephone Number	:	216-904-5452
Fax Number	:

Provider Business Practice Location Address
First Line	:	7315 DETROIT AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-3030
Country	:	US
Telephone Number	:	216-904-5452
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	LISA JACKSON
Credential	:
Telephone Number	:	216-904-5452

Provider Enumeration Date	:	11/30/2023
Last Update Date	:	11/30/2023

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