Provider Demographics
NPI:1821482563
Name:YOUNG, JIMMY DEWAYNE
Entity Type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:DEWAYNE
Last Name:YOUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10616 WOODLAND AVE # B
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44104-2436
Mailing Address - Country:US
Mailing Address - Phone:216-924-3071
Mailing Address - Fax:
Practice Address - Street 1:466 NORTHFIELD RD STE LL1
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-2289
Practice Address - Country:US
Practice Address - Phone:440-232-1330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide