Provider Demographics
NPI:1679205397
Name:YOUNG BROTHERS GROUP HOME LLC
Entity Type:Organization
Organization Name:YOUNG BROTHERS GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUGI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-714-0906
Mailing Address - Street 1:1787 S FOLLETT WAY
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-0272
Mailing Address - Country:US
Mailing Address - Phone:214-714-0906
Mailing Address - Fax:
Practice Address - Street 1:1787 S FOLLETT WAY
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-0272
Practice Address - Country:US
Practice Address - Phone:214-714-0906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care