Provider Demographics
NPI:1417405341
Name:YOUR SECOND FAMILY
Entity type:Organization
Organization Name:YOUR SECOND FAMILY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ERSKINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-558-2400
Mailing Address - Street 1:6659 PEARL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3821
Mailing Address - Country:US
Mailing Address - Phone:404-558-2400
Mailing Address - Fax:440-558-2346
Practice Address - Street 1:6659 PEARL RD STE 100
Practice Address - Street 2:
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3821
Practice Address - Country:US
Practice Address - Phone:404-558-2400
Practice Address - Fax:440-558-2346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0146044261QA0600X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0146044Medicaid