Organization
EXTENDED GRACE HOME CARE SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YALESIA N COOPER (OWNER)
(440) 453-8981
Entity
Organization
Contact information
Practice address
1905 N RIDGE RD E STE D, LORAIN, OH 44055-3344
(440) 412-9279
(440) 848-8894
Mailing address
5918 OLIVE AVE, NORTH RIDGEVILLE, OH 44039-1832
(440) 412-9279
(440) 848-8894
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0275647
—
OH
Enumeration date
12/16/2018
Last updated
12/16/2018
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