=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265858427
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIVING ASSISTANCE SERVICES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2014
-----------------------------------------------------
Last Update Date | 03/12/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 NORTHWEST AVE SUITE 200
-----------------------------------------------------
City | TALLMADGE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44278-1835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-733-1532
-----------------------------------------------------
Fax | 330-475-1373
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 NORTHWEST AVE SUITE 200
-----------------------------------------------------
City | TALLMADGE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44278-1835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-733-1532
-----------------------------------------------------
Fax | 330-475-1373
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. JUDITH L WOOD
-----------------------------------------------------
Credential | RN BSN
-----------------------------------------------------
Telephone | 330-733-1532
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------