Healthcare Provider Details

I. General information

NPI: 1700168010
Provider Name (Legal Business Name): EXTENDED HANDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7220 N LINDBERGH BLVD 290
HAZELWOOD MO
63042-2019
US

IV. Provider business mailing address

7220 N LINDBERGH BLVD 290
HAZELWOOD MO
63042-2019
US

V. Phone/Fax

Practice location:
  • Phone: 314-656-1376
  • Fax: 314-656-1556
Mailing address:
  • Phone: 314-656-1376
  • Fax: 314-656-1556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MS. BERYL DENISE BROWNING
Title or Position: OWNER
Credential: REGISTERED NURSE
Phone: 314-656-1376