Provider Demographics
NPI:1609584705
Name:YOUNG-LD SQUARED OUTPATIENT HEALTHCARE LLC
Entity Type:Organization
Organization Name:YOUNG-LD SQUARED OUTPATIENT HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LASHAMA
Authorized Official - Middle Name:ELIJISH-YOUNG
Authorized Official - Last Name:DEJESUS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:386-983-8488
Mailing Address - Street 1:673 N HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-8644
Mailing Address - Country:US
Mailing Address - Phone:386-983-8488
Mailing Address - Fax:
Practice Address - Street 1:673 N HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-8644
Practice Address - Country:US
Practice Address - Phone:386-983-8488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health