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General NPI Number Information
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NPI Number | 1437974219
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Entity Type | Organization
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Legal Business Name | EXTOL HAVEN HOME CARE LLC
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 2000 AUBURN DR STE 200
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City | BEACHWOOD
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State | OH
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Zip | 44122-4328
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Country | US
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Telephone | 216-453-8855
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Fax |
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Provider Business Mailing Address
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Address Line | 19412 GARDENVIEW DR
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City | MAPLE HEIGHTS
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State | OH
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Zip | 44137-2342
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Country | US
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Telephone | 216-505-3187
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PRINCE C UGWU
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Credential |
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Telephone | 216-453-8991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 372500000X
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Taxonomy Name | Chore Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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