Provider Demographics
NPI:1124851001
Name:YOUNG, MYRACLE RENEE
Entity type:Individual
Prefix:
First Name:MYRACLE
Middle Name:RENEE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 DARTFORD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-2304
Mailing Address - Country:US
Mailing Address - Phone:216-256-1477
Mailing Address - Fax:
Practice Address - Street 1:4100 DARTFORD RD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-2304
Practice Address - Country:US
Practice Address - Phone:216-256-1477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide