Provider Demographics
NPI:1508548298
Name:X-TRA MILE RESIDENTIAL CARE LLC
Entity Type:Organization
Organization Name:X-TRA MILE RESIDENTIAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:567-868-3670
Mailing Address - Street 1:5610 BROOK POINT RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43611-1406
Mailing Address - Country:US
Mailing Address - Phone:567-868-3670
Mailing Address - Fax:
Practice Address - Street 1:5610 BROOK POINT RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43611-1406
Practice Address - Country:US
Practice Address - Phone:567-868-3670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:X-TRA MLE RESIDENTIAL CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health