Provider Demographics
NPI:1710757208
Name:YOUNIVERSAL RESIDENTIAL CARE, LLC
Entity Type:Organization
Organization Name:YOUNIVERSAL RESIDENTIAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:IESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:757-237-1098
Mailing Address - Street 1:809 LIVE OAK DR STE 27
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2600
Mailing Address - Country:US
Mailing Address - Phone:757-904-1119
Mailing Address - Fax:757-299-7836
Practice Address - Street 1:809 LIVE OAK DR STE 27
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2600
Practice Address - Country:US
Practice Address - Phone:757-904-1119
Practice Address - Fax:757-299-7836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness