Organization
EXTENDED HEARTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARMEN JOINER (CEO)
(937) 287-7472
Entity
Organization
Contact information
Practice address
722 BLACKMOAT PL, MIAMISBURG, OH 45342-2725
(937) 287-7472
Mailing address
55 BECKLEY FARM WAY, SPRINGBORO, OH 45066-7508
(947) 287-7472
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
251J00000X
Nursing Care Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
253J00000X
Foster Care Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
310400000X
Assisted Living Facility
Primary
—
OH
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
313M00000X
Nursing Facility/Intermediate Care Facility
—
—
385H00000X
Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0196030
—
OH
Enumeration date
09/11/2017
Last updated
09/11/2017
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