Healthcare Provider Details

I. General information

NPI: 1548080922
Provider Name (Legal Business Name): XTENDED ARMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 WEBSTER ST
FAIRFIELD CA
94533-4841
US

IV. Provider business mailing address

PO BOX 1328
SUISUN CITY CA
94585-4328
US

V. Phone/Fax

Practice location:
  • Phone: 510-362-9116
  • Fax:
Mailing address:
  • Phone: 510-362-9116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLEE ESPADRON
Title or Position: CEO
Credential:
Phone: 510-362-9116