Healthcare Provider Details

I. General information

NPI: 1487669115
Provider Name (Legal Business Name): EXTENDICARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 02/29/2024
Certification Date: 12/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 S SAINT ANDREWS ST
DOTHAN AL
36301-3684
US

IV. Provider business mailing address

PMB 391 104 APPLE AVE SUITE 3
DOTHAN AL
36303
US

V. Phone/Fax

Practice location:
  • Phone: 334-793-1177
  • Fax: 334-699-3948
Mailing address:
  • Phone: 334-793-1177
  • Fax: 334-699-3948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberN3501
License Number StateAL

VIII. Authorized Official

Name: DAVID DENNIS
Title or Position: CEO
Credential:
Phone: 334-793-1177