Healthcare Provider Details

I. General information

NPI: 1952603516
Provider Name (Legal Business Name): EXTRAHELP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 12/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1259 MARINA PT APT 301
CASSELBERRY FL
32707-6476
US

IV. Provider business mailing address

13200 W NEWBERRY RD APT J50
NEWBERRY FL
32669-2770
US

V. Phone/Fax

Practice location:
  • Phone: 352-474-8492
  • Fax: 352-332-7187
Mailing address:
  • Phone: 352-474-8492
  • Fax: 352-332-7187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. ANATOLY NICKOLAY LUKYANOV
Title or Position: PRESIDENT
Credential: PHD
Phone: 352-474-8492