=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821539974
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A LITTLE SOMETHING EXXTRA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2017
-----------------------------------------------------
Last Update Date | 08/03/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8536 CROW DR STE 215
-----------------------------------------------------
City | MACEDONIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44056-1900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-772-7062
-----------------------------------------------------
Fax | 216-916-4747
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8536 CROW DR STE 215
-----------------------------------------------------
City | MACEDONIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44056-1900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-772-7062
-----------------------------------------------------
Fax | 216-916-4747
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | TANISHA BRUNSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 216-903-1330
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------