YOUNG HEARTS EXTENDED ASSISTED LIVING FACILITY, LLC (NPI# 1497219133) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497219133 |
| Entity Type | Organization |
| Organization Name | YOUNG HEARTS EXTENDED ASSISTED LIVING FACILITY, LLC |
| Practice Address |
1410 Ne 219th St Lawtey FL 32058-4387 |
| Practice Telephone | 9047691122 |
| Mailing Telephone | 9047691122 |
| Enumeration Date | 2019-01-28 |
| Last Update Date | 2019-01-28 |
| Authorized Official Name | MS. NIKITA LATRICE JENKINS (RN/ADMINISTRATOR) |
| Authorized Official Telephone | 9047691122 |
| Authorized Official Credential | RN, RN-BC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | Nursing & Custodial Care Facilities |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | YOUNG HEARTS EXTENDED ASSISTED LIVING FACILITY, LLC | 1410 Ne 219th St, Lawtey, FL 32058-4387 |
| Street Address |
1410 NE 219TH ST |
| City | LAWTEY |
| State | FL |
| Zip Code | 32058-4387 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306352570 | Nikita L Jenkins | Registered Nurse | 1410 Ne 219th St, Lawtey, FL 32058-4387 | 2017-12-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447781067 | Ryan Hendrieth | Nurse's Aide | 1701 Adams St Apt 27, Lawtey, FL 32058-3899 | 2017-03-24 |
| 1528675162 | Ct Counseling, LLC | Counselor | 23051 Nw County Road 200a, Lawtey, FL 32058-4215 | 2020-09-28 |
| 1154920767 | Christina Tatum | Counselor | 23051 Nw County Road 200a, Lawtey, FL 32058-4215 | 2020-10-23 |
| 1487088068 | Turosia Evette Bright | Licensed Practical Nurse | 21301 Ne 14th Ave, Lawtey, FL 32058-4336 | 2013-08-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528675162 | Ct Counseling, LLC | Counselor | 23051 Nw County Road 200a, Lawtey, FL 32058-4215 | 2020-09-28 |
| 1447781067 | Ryan Hendrieth | Nurse's Aide | 1701 Adams St Apt 27, Lawtey, FL 32058-3899 | 2017-03-24 |
| 1487088068 | Turosia Evette Bright | Licensed Practical Nurse | 21301 Ne 14th Ave, Lawtey, FL 32058-4336 | 2013-08-30 |
| 1154920767 | Christina Tatum | Counselor | 23051 Nw County Road 200a, Lawtey, FL 32058-4215 | 2020-10-23 |
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
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| 1194326728 | Bliss Life Residential Care | Assisted Living Facility | 402 Arthur Ave, Lehigh Acres, FL 33936-7412 | 2020-11-02 |
| 1811597404 | Huguette Mortimer Dupont | Assisted Living Facility | 1596 Sw Paar Dr, Port St Lucie, FL 34953-6159 | 2020-11-01 |
| 1750981841 | Senior Living Properties IIi, LLC | Assisted Living Facility | 3791 Old Canoe Creek Rd, Saint Cloud, FL 34769-6630 | 2020-10-28 |
| 1417556028 | 5081 Cambridge LLC | Assisted Living Facility | 5081 Nw Dunn Rd, Fort Pierce, FL 34981-4942 | 2020-10-23 |
| 1134728926 | Pacifica Lauderhill LLC | Assisted Living Facility | 5500 Nw 69th Ave, Lauderhill, FL 33319-7266 | 2020-10-22 |
| 1760081749 | Hsre-ahr Zephyrhills LLC | Assisted Living Facility | 38130 Pretty Pond Road, Zephyrhills, FL 33540 | 2020-10-21 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.