Provider Demographics
NPI:1851400477
Name:JAMES B YOUNG
Entity Type:Organization
Organization Name:JAMES B YOUNG
Other - Org Name:HOMEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BAUGHER
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-333-8963
Mailing Address - Street 1:425 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-5504
Mailing Address - Country:US
Mailing Address - Phone:253-333-8963
Mailing Address - Fax:253-333-5063
Practice Address - Street 1:425 E MAIN ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-5504
Practice Address - Country:US
Practice Address - Phone:253-333-8963
Practice Address - Fax:253-333-5063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA82-00983OtherEVERCARE
WA9048141Medicaid
WA9058322Medicaid
WA9058322Medicaid
WA9058322Medicaid