NPIMap

Organization Active NPI

Young Hearts Extended Assisted Living Facility, LLC

Doing business as Young Hearts In-Home Senior Care

  • Homemaker
  • Lawtey, FL
National Provider Identifier
1649863440
Registry record updated Feb 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
HomemakerTaxonomy code 376J00000X
Legal business name
YOUNG HEARTS EXTENDED ASSISTED LIVING FACILITY, LLC
Doing business as
Young Hearts In-Home Senior Care
Practice address
1410 NE 219TH St
Lawtey, FL 32058-4387
Phone
(904) 769-1122
NPI assigned
Feb 12, 2021
Last updated
Feb 26, 2021By 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 26, 2021

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

Authorized official

Name
Ms. Nikita 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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Companion 372600000X
Homemaker 376J00000X Primary

Addresses

Primary practice location

1410 NE 219TH St
Lawtey, FL 32058-4387

Mailing address

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

Other names 1

  • Young Hearts In-Home Senior Care 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": "1613088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614297600000",
    "number": "1649863440",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1410 NE 219TH ST",
            "city": "LAWTEY",
            "state": "FL",
            "postal_code": "320584387",
            "telephone_number": "904-769-1122"
        }
    ],
    "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": "2021-02-12",
        "last_updated": "2021-02-26",
        "certification_date": "2021-02-26",
        "status": "A",
        "authorized_official_last_name": "JENKINS",
        "authorized_official_first_name": "NIKITA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "904-769-1122",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "372600000X",
            "taxonomy_group": "",
            "desc": "Adult Companion",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "376J00000X",
            "taxonomy_group": "",
            "desc": "Homemaker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Young Hearts In-Home Senior Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Young Hearts In-Home Senior Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lawtey, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2021; 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.