Provider Demographics
NPI:1821451261
Name:EXTENDED ARMS LLC
Entity Type:Organization
Organization Name:EXTENDED ARMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-693-6988
Mailing Address - Street 1:3305 WOODBURN AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45207-1535
Mailing Address - Country:US
Mailing Address - Phone:513-693-6988
Mailing Address - Fax:
Practice Address - Street 1:3305 WOODBURN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45207-1535
Practice Address - Country:US
Practice Address - Phone:513-693-6988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-02
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services