Provider Demographics
NPI:1568895084
Name:YOUN
Entity Type:Organization
Organization Name:YOUN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STNA
Authorized Official - Prefix:MISS
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:LASHAUN
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-270-4012
Mailing Address - Street 1:1709 FREEMAN ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-4446
Mailing Address - Country:US
Mailing Address - Phone:419-270-4012
Mailing Address - Fax:
Practice Address - Street 1:1709 FREEMAN ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-4446
Practice Address - Country:US
Practice Address - Phone:419-270-4012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400916240509251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health