Provider Demographics
NPI:1811745490
Name:YGGDRASIL RESIDENTIAL SERVICES
Entity type:Organization
Organization Name:YGGDRASIL RESIDENTIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITEHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-257-3815
Mailing Address - Street 1:72480 PATTONS RUN RD
Mailing Address - Street 2:
Mailing Address - City:MARTINS FERRY
Mailing Address - State:OH
Mailing Address - Zip Code:43935-9793
Mailing Address - Country:US
Mailing Address - Phone:740-257-3815
Mailing Address - Fax:
Practice Address - Street 1:72480 PATTONS RUN RD
Practice Address - Street 2:
Practice Address - City:MARTINS FERRY
Practice Address - State:OH
Practice Address - Zip Code:43935-9793
Practice Address - Country:US
Practice Address - Phone:740-257-3815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-09
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No253Z00000XAgenciesIn Home Supportive Care