Healthcare Provider Details

I. General information

NPI: 1275078693
Provider Name (Legal Business Name): XTRA TOUCH HOMECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2016
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1257 E LINWOOD DR
MOBILE AL
36605-2263
US

IV. Provider business mailing address

1257 E LINWOOD DR
MOBILE AL
36605-2263
US

V. Phone/Fax

Practice location:
  • Phone: 251-605-7955
  • Fax:
Mailing address:
  • Phone: 251-605-7955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number064632
License Number StateAL

VIII. Authorized Official

Name: JOSETTE NATASHA DAVIS
Title or Position: CARGIVER/HOMEMAKER
Credential: NURSING ASSISTANT
Phone: 251-605-7955