NPIMap

Organization Active NPI

Young Hearts Extended Assisted Living Facility, LLC

Doing business as Young Hearts Extended Assisted Living Facility II

  • Assisted Living Facility
  • Starke, FL
National Provider Identifier
1518723535
Registry record updated Feb 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
Legal business name
YOUNG HEARTS EXTENDED ASSISTED LIVING FACILITY, LLC
Doing business as
Young Hearts Extended Assisted Living Facility II
Practice address
329 N Church St
Starke, FL 32091-3434
Phone
(904) 769-1122
Fax
(206) 844-9037
NPI assigned
Feb 27, 2024
Last updated
Feb 27, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
YOUNG HEARTS EXTENDED ASSISTED LIVING FACILITY LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 27, 2024

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

Authorized official

Name
Ms. Nikita L Jenkins, RNNPI 1306352570
Title
Administrator
Phone
(904) 769-1122

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X NU Primary

Addresses

Primary practice location

329 N Church St
Starke, FL 32091-3434

Mailing address

1410 NE 219TH St
Lawtey, FL 32058-4387
Phone (904) 769-1122

Other names 1

  • Young Hearts Extended Assisted Living Facility II Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Young Hearts Extended Assisted Living Facility LLC4 organizations share this tax ID, including this one
Part of
Young Hearts Extended Assisted Living Facility LLC

Other organizations with this tax ID 3

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1708992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708992000000",
    "number": "1518723535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1410 NE 219TH ST",
            "city": "LAWTEY",
            "state": "FL",
            "postal_code": "320584387",
            "telephone_number": "904-769-1122",
            "fax_number": "206-844-9037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "329 N CHURCH ST",
            "city": "STARKE",
            "state": "FL",
            "postal_code": "320913434",
            "telephone_number": "904-769-1122",
            "fax_number": "206-844-9037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOUNG HEARTS EXTENDED ASSISTED LIVING FACILITY, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "YOUNG HEARTS EXTENDED ASSISTED LIVING FACILITY LLC",
        "enumeration_date": "2024-02-27",
        "last_updated": "2024-02-27",
        "certification_date": "2024-02-27",
        "status": "A",
        "authorized_official_last_name": "JENKINS",
        "authorized_official_first_name": "NIKITA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "904-769-1122",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Young Hearts Extended Assisted Living Facility II",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Starke, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.