Provider Demographics
NPI:1275968315
Name:YODER SUPPORTED LIVING SERVICES, INC.
Entity Type:Organization
Organization Name:YODER SUPPORTED LIVING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:YODER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-477-1498
Mailing Address - Street 1:5651 BRADFORD RD
Mailing Address - Street 2:
Mailing Address - City:WEST FARMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:44491-9716
Mailing Address - Country:US
Mailing Address - Phone:440-477-1498
Mailing Address - Fax:
Practice Address - Street 1:5651 BRADFORD RD
Practice Address - Street 2:
Practice Address - City:WEST FARMINGTON
Practice Address - State:OH
Practice Address - Zip Code:44491-9716
Practice Address - Country:US
Practice Address - Phone:440-527-0629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-09
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 251X00000X, 253Z00000X, 347C00000X
OH251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No251X00000XAgenciesSupports Brokerage
No253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHM7800820OtherPROVIDER NUMBER FROM OHIO DEPARTMENT OF DEVELOPMENTAL DISABILITIES