Healthcare Provider Details

I. General information

NPI: 1699253260
Provider Name (Legal Business Name): XTREME HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2018
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 TREEHILLS PKWY
STONE MOUNTAIN GA
30088-3045
US

IV. Provider business mailing address

706 TREEHILLS PKWY
STONE MOUNTAIN GA
30088-3045
US

V. Phone/Fax

Practice location:
  • Phone: 678-876-7553
  • Fax: 470-375-3920
Mailing address:
  • Phone: 678-876-7553
  • Fax: 470-375-3920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: SHANTAIN CURRY
Title or Position: OWNER
Credential:
Phone: 678-876-7553