Healthcare Provider Details

I. General information

NPI: 1083080287
Provider Name (Legal Business Name): EXTRA HELP HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 MARCHWOOD CV
LITTLE ROCK AR
72210-3704
US

IV. Provider business mailing address

16 MARCHWOOD CV
LITTLE ROCK AR
72210-3704
US

V. Phone/Fax

Practice location:
  • Phone: 501-366-3585
  • Fax: 501-414-8092
Mailing address:
  • Phone: 501-366-3585
  • Fax: 501-414-8092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number032359
License Number StateAR

VIII. Authorized Official

Name: HARRY BASSETT
Title or Position: CEO
Credential: BACHELOR BUSINESS
Phone: 501-366-3585