Healthcare Provider Details

I. General information

NPI: 1477377448
Provider Name (Legal Business Name): EXTRAORDINARY HOME CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 OSWEGO AVE
BALTIMORE MD
21215-7037
US

IV. Provider business mailing address

1908 DRUID HILL AVE
BALTIMORE MD
21217-3502
US

V. Phone/Fax

Practice location:
  • Phone: 443-229-2892
  • Fax:
Mailing address:
  • Phone: 215-528-2448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHIRELLE A ROBINSON
Title or Position: CEO
Credential:
Phone: 215-528-2448