Organization
VANCLEEF PERSONAL CARE HOMES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERMAINE YOUNG (CEO)
(773) 441-1910
Entity
Organization
Contact information
Practice address
1060 E COUNTY LINE RD STE 3A-328, RIDGELAND, MS 39157-1900
(773) 441-1910
(414) 386-7918
Mailing address
1060 E COUNTY LINE RD STE 3A-328, RIDGELAND, MS 39157-1900
(773) 441-1910
(414) 386-7918
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
311ZA0620X
Adult Care Home Facility
—
—
376J00000X
Homemaker
—
—
Other
Enumeration date
07/24/2019
Last updated
07/24/2019
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