Provider Demographics
NPI:1205570942
Name:YOUNG 60 PLUS CLUB LLC.
Entity type:Organization
Organization Name:YOUNG 60 PLUS CLUB LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRITTNEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:JETER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN, IPN, MA,
Authorized Official - Phone:833-960-7587
Mailing Address - Street 1:4437 LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-2317
Mailing Address - Country:US
Mailing Address - Phone:833-960-7587
Mailing Address - Fax:309-882-0065
Practice Address - Street 1:4437 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2317
Practice Address - Country:US
Practice Address - Phone:833-960-7587
Practice Address - Fax:309-882-0065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-27
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day CareGroup - Single Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty