Healthcare Provider Details

I. General information

NPI: 1023134491
Provider Name (Legal Business Name): EXTRA HANDS INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

937 BROADWAY SUITE 103
CAPE GIRARDEAU MO
63701-5474
US

IV. Provider business mailing address

937 BROADWAY SUITE 103
CAPE GIRARDEAU MO
63701-5474
US

V. Phone/Fax

Practice location:
  • Phone: 573-334-5333
  • Fax: 573-334-4031
Mailing address:
  • Phone: 573-334-5333
  • Fax: 573-334-4031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number3176 7622
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License NumberDA8020
License Number StateMO

VIII. Authorized Official

Name: KATHY YVONNE SMITH
Title or Position: OWNER PRESIDENT
Credential:
Phone: 573-334-5333