Provider Demographics
NPI:1295102432
Name:EXPAND YOUR WINGS HOME HEALTH CARE
Entity type:Organization
Organization Name:EXPAND YOUR WINGS HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LASHELL
Authorized Official - Middle Name:D
Authorized Official - Last Name:ELSAYED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-792-5735
Mailing Address - Street 1:2152 S RACCOON RD # TH35
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-5215
Mailing Address - Country:US
Mailing Address - Phone:330-792-5735
Mailing Address - Fax:330-792-5735
Practice Address - Street 1:2152 S RACCOON RD # TH35
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-5215
Practice Address - Country:US
Practice Address - Phone:330-792-5735
Practice Address - Fax:330-792-5735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2954254Medicaid