Healthcare Provider Details

I. General information

NPI: 1417405341
Provider Name (Legal Business Name): YOUR SECOND FAMILY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2016
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6659 PEARL RD STE 100
PARMA HEIGHTS OH
44130-3821
US

IV. Provider business mailing address

6659 PEARL RD STE 100
PARMA HEIGHTS OH
44130-3821
US

V. Phone/Fax

Practice location:
  • Phone: 404-558-2400
  • Fax: 440-558-2346
Mailing address:
  • Phone: 404-558-2400
  • Fax: 440-558-2346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number0146044
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number0146044
License Number StateOH

VIII. Authorized Official

Name: MEGAN L ERSKINE
Title or Position: PROGRAM COORDINATOR
Credential:
Phone: 440-558-2400