Healthcare Provider Details

I. General information

NPI: 1467133702
Provider Name (Legal Business Name): XTENSION OF CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

934 PEMBROOK RD
CLEVELAND HTS OH
44121-1402
US

IV. Provider business mailing address

12200 FAIRHILL RD STE B221
CLEVELAND OH
44120-1058
US

V. Phone/Fax

Practice location:
  • Phone: 216-760-9591
  • Fax:
Mailing address:
  • Phone: 216-242-6447
  • Fax: 216-232-6274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. LAKIA LANE-COKER
Title or Position: CEO
Credential:
Phone: 216-242-6447