MEDICARE: YOUR SECOND FAMILY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	385H00000X	Respite Care	0146044	OH
2	261QA0600X	Adult Day Care Clinic/Center	0146044	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417405341
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUR SECOND FAMILY

Provider Business Mailing Address
First Line	:	6659 PEARL RD STE 100
Second Line	:
City	:	PARMA HEIGHTS
State	:	OH
Zip	:	44130-3821
Country	:	US
Telephone Number	:	404-558-2400
Fax Number	:	440-558-2346

Provider Business Practice Location Address
First Line	:	6659 PEARL RD STE 100
Second Line	:
City	:	PARMA HEIGHTS
State	:	OH
Zip	:	44130-3821
Country	:	US
Telephone Number	:	404-558-2400
Fax Number	:	440-558-2346

Authorized Official
Title or Position	:	PROGRAM COORDINATOR
Name	:	MEGAN L ERSKINE
Credential	:
Telephone Number	:	440-558-2400

Provider Enumeration Date	:	09/20/2016
Last Update Date	:	05/20/2024

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Directions to “YOUR SECOND FAMILY ” Practice Location

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