Healthcare Provider Details

I. General information

NPI: 1467293548
Provider Name (Legal Business Name): EXTENDED KIDS CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 NW 101ST LN UNIT 101
CORAL SPRINGS FL
33065-3930
US

IV. Provider business mailing address

3000 NW 101ST LN UNIT 101
CORAL SPRINGS FL
33065-3930
US

V. Phone/Fax

Practice location:
  • Phone: 754-241-5305
  • Fax: 754-241-5471
Mailing address:
  • Phone: 786-603-9377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QM3000X
TaxonomyMedically Fragile Infants and Children Day Care
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: RACHEL HERRERA RODRIGUEZ
Title or Position: PRESIDENT
Credential: APRN, FNP-C
Phone: 786-603-9377