Healthcare Provider Details

I. General information

NPI: 1275968315
Provider Name (Legal Business Name): YODER SUPPORTED LIVING SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2013
Last Update Date: 11/28/2020
Certification Date: 11/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5651 BRADFORD RD
WEST FARMINGTON OH
44491-9716
US

IV. Provider business mailing address

5651 BRADFORD RD
WEST FARMINGTON OH
44491-9716
US

V. Phone/Fax

Practice location:
  • Phone: 440-527-0629
  • Fax:
Mailing address:
  • Phone: 440-477-1498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MARTHA CAROL YODER
Title or Position: DIRECTOR
Credential:
Phone: 440-477-1498