Healthcare Provider Details

I. General information

NPI: 1922883420
Provider Name (Legal Business Name): EXTENDED FAMILY HOME HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2023
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 N NELSON AVE
WILMINGTON OH
45177-8348
US

IV. Provider business mailing address

717 N NELSON AVE
WILMINGTON OH
45177-8348
US

V. Phone/Fax

Practice location:
  • Phone: 937-768-1556
  • Fax: 937-915-2060
Mailing address:
  • Phone: 937-768-1556
  • Fax: 937-915-2060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. ROBIN VAUGHN
Title or Position: ADMINISTRATOR, OWNER, DON, RN, MSN
Credential: RN, MSN
Phone: 937-768-1556