MEDICARE: EXTENDED CARE SUPPORT, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417009903
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXTENDED CARE SUPPORT, INC.

Provider Business Mailing Address
First Line	:	1900 7TH ST
Second Line	:	SUITE A
City	:	RICHMOND
State	:	CA
Zip	:	94801-1640
Country	:	US
Telephone Number	:	510-233-7332
Fax Number	:	510-233-7892

Provider Business Practice Location Address
First Line	:	1900 7TH ST
Second Line	:	SUITE A
City	:	RICHMOND
State	:	CA
Zip	:	94801-1640
Country	:	US
Telephone Number	:	510-233-7332
Fax Number	:	510-233-7892

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAMES A CASSIN
Credential	:
Telephone Number	:	510-233-7332

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	08/22/2020

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