Provider Demographics
NPI:1669750337
Name:YOUNG, NANCY (FOSTER CARE PROVIDER)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:FOSTER CARE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12450 FOLKS RD
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MI
Mailing Address - Zip Code:49241-9749
Mailing Address - Country:US
Mailing Address - Phone:517-524-6698
Mailing Address - Fax:
Practice Address - Street 1:12450 FOLKS RD
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MI
Practice Address - Zip Code:49241-9749
Practice Address - Country:US
Practice Address - Phone:517-524-6698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICG380297334171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator