MEDICARE: XTENDED HANDS HOMECARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1679154249
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	XTENDED HANDS HOMECARE

Provider Business Mailing Address
First Line	:	1725 W GLENDALE AVE APT 2091
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-8809
Country	:	US
Telephone Number	:	623-387-0770
Fax Number	:

Provider Business Practice Location Address
First Line	:	1725 W GLENDALE AVE APT 2091
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-8809
Country	:	US
Telephone Number	:	623-387-0770
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LORNA RENEE JACKSON
Credential	:	CNA
Telephone Number	:	623-387-0770

Provider Enumeration Date	:	04/15/2021
Last Update Date	:	04/16/2021

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Directions to “XTENDED HANDS HOMECARE ” Practice Location

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