Provider Demographics
NPI:1508352121
Name:JYLHA, DAVID LEVI
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LEVI
Last Name:JYLHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 COUNTY RD 480
Mailing Address - Street 2:
Mailing Address - City:NEGAUNEE
Mailing Address - State:MI
Mailing Address - Zip Code:49866
Mailing Address - Country:US
Mailing Address - Phone:906-401-0030
Mailing Address - Fax:
Practice Address - Street 1:225 COUNTY RD 480
Practice Address - Street 2:
Practice Address - City:NEGAUNEE
Practice Address - State:MI
Practice Address - Zip Code:49866
Practice Address - Country:US
Practice Address - Phone:906-401-0030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAF520338326311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home