Provider Demographics
NPI:1093153504
Name:YOUNG AT HEART ADULT CARE, INC.
Entity Type:Organization
Organization Name:YOUNG AT HEART ADULT CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-629-4417
Mailing Address - Street 1:26563 SANDHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33983-6310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:26563 SANDHILL BLVD
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33983-6310
Practice Address - Country:US
Practice Address - Phone:941-629-4417
Practice Address - Fax:941-629-4964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL8481302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000936700Medicare PIN