Provider Demographics
NPI:1700083524
Name:C.C. YOUNG MEMORIAL HOME
Entity Type:Organization
Organization Name:C.C. YOUNG MEMORIAL HOME
Other - Org Name:C.C. YOUNG HOME HEALTH AND HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:214-841-2825
Mailing Address - Street 1:4847 W. LAWTHER DR.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214
Mailing Address - Country:US
Mailing Address - Phone:214-841-2825
Mailing Address - Fax:214-273-9671
Practice Address - Street 1:4849 W LAWTHER DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-1879
Practice Address - Country:US
Practice Address - Phone:214-841-2825
Practice Address - Fax:214-370-2830
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:C.C. YOUNG MEMORIAL HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-27
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251G00000X
TX451790315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001013912Medicaid
TX001013912Medicaid