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General NPI Number Information
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NPI Number | 1659122836
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Entity Type | Organization
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Legal Business Name | EXTENDED SUPPORT SERVICES, INC.
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Dates
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Enumeration Date | 03/27/2024
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Last Update Date | 03/27/2024
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Provider Practice Location Address
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Address Line | 131 LINGENFELTER RD
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City | BEDFORD
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State | PA
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Zip | 15522-6636
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Country | US
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Telephone | 814-623-1770
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 620
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City | BEDFORD
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State | PA
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Zip | 15522-0620
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Country | US
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Telephone | 814-623-1770
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GENNIFER WASHINGTON
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Credential | LCSW
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Telephone | 814-623-1770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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