C C Young Memorial Home

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

110990 Issued in TX

Legal business name

C C YOUNG MEMORIAL HOME

Practice address

4849 W Lawther Dr
Dallas, TX 75214-1879

Phone

(214) 827-8080

Fax

(214) 370-2830

NPI assigned

Sep 12, 2005

Last updated

Apr 4, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Catherine Anne Thomas, RN

Title

Admin

Phone

(214) 841-2825

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043205479. Details of each certification follow.

• CCN 675592 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 675592

Legal name

C.C. YOUNG MEMORIAL HOME

Certification status

Active

Provider type (POS)

Nursing home – SNF (Medicare) only

Participating since

May 2, 1996

Last certification

Oct 3, 2024

Beds

129

Ownership / control type

Nonprofit Corporation

Organization structure

CorporationNon-profit

Incorporated

Mar 17, 1922 in TX

Enrollment address

4829 W Lawther Dr
Suite 100
Dallas, TX 75214-1858

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• C.C. Young Memorial Home

  dba C.C. Young Home Health

  • Home Health Agency
  • Dallas, TX
  • NPI 1326231499

  2365406279

  Same PAC ID
• C.C. Young Memorial Home

  dba C.C. Young Home Health and Hospice

  • Community Based Hospice Care Agency
  • Dallas, TX
  • NPI 1700083524

  2365406279

  Same PAC ID

Listed as

C C Young Memorial HomeCCN 675592 · All quality measures

Overall star rating

5 of 5

Health inspections

5 of 5

Staffing

5 of 5

Quality measures

5 of 5

Type

Medicare

Ownership

Non profit - Corporation

Certified

May 2, 1996

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

129119.2 residents per day on average

Processed by Care Compare on Aug 1, 2026.

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

St Joseph Hospital3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• C.C. Young Memorial Home

  dba C.C. Young Home Health

  • Home Health Agency
  • Dallas, TX
  • NPI 1326231499
  NPD tax ID
• C.C. Young Memorial Home

  dba C.C. Young Home Health and Hospice

  • Community Based Hospice Care Agency
  • Dallas, TX
  • NPI 1700083524
  NPD tax ID

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Jane Farrar Admire, MD

  • Otolaryngology Physician
  • Dallas, TX
  • NPI 1023139433

  Corporate Director

  CMS ownership

Affiliated clinicians 7

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Amanda Abbott, D.O.

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Dallas, TX
  • NPI 1275069981

  Nursing home

  Care Compare affiliation
• Rui Carlos Benevides II, M.D.

  • Internal Medicine Physician
  • Dallas, TX
  • NPI 1093973216

  Nursing home

  Care Compare affiliation
• Christopher R Chumley, MD

  • General Practice Physician
  • Dallas, TX
  • NPI 1982803664

  Nursing home

  Care Compare affiliation
• Grady G. Goodwin, M.D.

  • Internal Medicine Physician
  • Dallas, TX
  • NPI 1407964158

  Nursing home

  Care Compare affiliation
• Karishma Khan, M.D.

  • Internal Medicine Physician
  • Dallas, TX
  • NPI 1780845891

  Nursing home

  Care Compare affiliation
• Paul C Peters Jr., M.D.

  • Orthopaedic Surgery Physician
  • Dallas, TX
  • NPI 1356498299

  Nursing home

  Care Compare affiliation
• James Conner Ryan, MD

  • Adult Reconstructive Orthopaedic Surgery Physician
  • Plano, TX
  • NPI 1386098150

  Nursing home

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649030400000",
    "number": "1043205479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4847 W LAWTHER DR",
            "address_2": "SUITE #100",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752141853",
            "telephone_number": "214-827-8080",
            "fax_number": "214-841-2890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4849 W LAWTHER DR",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752141879",
            "telephone_number": "214-827-8080",
            "fax_number": "214-370-2830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "C C YOUNG MEMORIAL HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-12",
        "last_updated": "2022-04-04",
        "certification_date": "2022-04-04",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "CATHERINE",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "ADMIN",
        "authorized_official_telephone_number": "214-841-2825",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": "110990",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000464001",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gokul K Bysani, MD
• Stephanie Sooyeon Byun, MD
• C a Bloom MD PLLC
• C and I International Inc (Preston Village Pharmacy)
• C and I International Inc. (C and I Pharmacy)
• C Daryl Curry MD PA
• C F & H Corporation (South Dallas Nursing Home)
• C Folashade Ogunro MD PA
• Brittney Leah C Lay, CPM
• C Lee Group LLC

• Skilled Nursing Facility in Dallas, TX
• Providers in Dallas, TX by specialty
• Skilled Nursing Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.