Provider Demographics
NPI:1982968301
Name:YOUR INDEPENDENCE INC
Entity Type:Organization
Organization Name:YOUR INDEPENDENCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:K
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-287-4157
Mailing Address - Street 1:1557 VERNON ODOM BLVD
Mailing Address - Street 2:104
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-4061
Mailing Address - Country:US
Mailing Address - Phone:866-287-4157
Mailing Address - Fax:330-983-9494
Practice Address - Street 1:1557 VERNON ODOM BLVD
Practice Address - Street 2:104
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-4061
Practice Address - Country:US
Practice Address - Phone:866-287-4157
Practice Address - Fax:330-983-9494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-29
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7706870251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2760650Medicaid