Provider Demographics
NPI:1184648016
Name:YOUNG, GINA R (HHA)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:R
Last Name:YOUNG
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4472 BRIDLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-1439
Mailing Address - Country:US
Mailing Address - Phone:513-885-2136
Mailing Address - Fax:
Practice Address - Street 1:4472 BRIDLEWOOD LN
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-1439
Practice Address - Country:US
Practice Address - Phone:513-885-2136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2432086Medicaid