Healthcare Provider Details

I. General information

NPI: 1700184918
Provider Name (Legal Business Name): DDEXTENDED CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2011
Last Update Date: 03/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 EVAN RD
WARWICK NY
10990-4022
US

IV. Provider business mailing address

139 EVAN RD
WARWICK NY
10990-4022
US

V. Phone/Fax

Practice location:
  • Phone: 845-987-8408
  • Fax:
Mailing address:
  • Phone: 845-987-8408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number625885
License Number StateNY

VIII. Authorized Official

Name: MRS. DAWN BROWN
Title or Position: RN
Credential:
Phone: 845-987-8408