Provider Demographics
NPI:1093910655
Name:YOUVILLE HOUSE, INC
Entity Type:Organization
Organization Name:YOUVILLE HOUSE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEXUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-491-1234
Mailing Address - Street 1:1573 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4377
Mailing Address - Country:US
Mailing Address - Phone:617-491-1234
Mailing Address - Fax:617-491-8838
Practice Address - Street 1:1573 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4377
Practice Address - Country:US
Practice Address - Phone:617-491-1234
Practice Address - Fax:617-491-8838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1903578Medicaid