Healthcare Provider Details

I. General information

NPI: 1609446798
Provider Name (Legal Business Name): EXTRA CARE FOR THE PALM BEACHES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1499 FOREST HILL BLVD STE 117
WEST PALM BEACH FL
33406-6050
US

IV. Provider business mailing address

1499 FOREST HILL BLVD STE 117
WEST PALM BEACH FL
33406-6050
US

V. Phone/Fax

Practice location:
  • Phone: 561-870-3312
  • Fax:
Mailing address:
  • Phone: 561-870-3312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: GERALDA BROWN
Title or Position: PRESIDENT/ALT ADMIN/CFO
Credential:
Phone: 561-302-1150