Healthcare Provider Details

I. General information

NPI: 1588555239
Provider Name (Legal Business Name): EXTRAORDINARY HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2025
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 SHADY PINES DR
BEASLEY TX
77417-1330
US

IV. Provider business mailing address

PO BOX 1482
MISSOURI CITY TX
77459-8482
US

V. Phone/Fax

Practice location:
  • Phone: 905-503-5305
  • Fax:
Mailing address:
  • Phone: 905-503-5305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: ROATESS REEVES
Title or Position: ADMINISTRATOR
Credential: LPN
Phone: 903-503-5305