Provider Demographics
NPI:1710913132
Name:YOUNG TIGERS INC.
Entity Type:Organization
Organization Name:YOUNG TIGERS INC.
Other - Org Name:TOTAL CARE HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RN/IDPCS
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:NONYELUM
Authorized Official - Last Name:AGUDE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:951-317-9175
Mailing Address - Street 1:7130 MAGNOLIA AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-3840
Mailing Address - Country:US
Mailing Address - Phone:951-788-0202
Mailing Address - Fax:951-788-0202
Practice Address - Street 1:7130 MAGNOLIA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-3840
Practice Address - Country:US
Practice Address - Phone:951-788-0202
Practice Address - Fax:951-788-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05-8325Medicare ID - Type Unspecified