Provider Demographics
NPI:1417009903
Name:EXTENDED CARE SUPPORT, INC.
Entity Type:Organization
Organization Name:EXTENDED CARE SUPPORT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:CASSIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-233-7332
Mailing Address - Street 1:1900 7TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94801-1640
Mailing Address - Country:US
Mailing Address - Phone:510-233-7332
Mailing Address - Fax:510-233-7892
Practice Address - Street 1:1900 7TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94801-1640
Practice Address - Country:US
Practice Address - Phone:510-233-7332
Practice Address - Fax:510-233-7892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME01630FMedicaid
CADME01630FMedicaid