Provider Demographics
NPI:1598166043
Name:YOUTHFUL AGING HEALTH CENTER INC
Entity Type:Organization
Organization Name:YOUTHFUL AGING HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:NICCI
Authorized Official - Middle Name:
Authorized Official - Last Name:KOBRITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-925-9532
Mailing Address - Street 1:5602 MARQUESAS CIR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-3310
Mailing Address - Country:US
Mailing Address - Phone:941-925-9532
Mailing Address - Fax:941-925-9628
Practice Address - Street 1:5602 MARQUESAS CIR
Practice Address - Street 2:SUITE 105
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-3310
Practice Address - Country:US
Practice Address - Phone:941-925-9532
Practice Address - Fax:941-925-9628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-15
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty