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General NPI Number Information
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NPI Number | 1174793996
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Entity Type | Organization
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Legal Business Name | X-TREME CARE, LLC
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Dates
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Enumeration Date | 03/07/2008
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Last Update Date | 07/15/2021
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Provider Practice Location Address
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Address Line | 212-12 NORTHER BLVD 3RD FLOOR
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City | BAY SIDE
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State | NY
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Zip | 11361
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Country | US
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Telephone | 718-461-9602
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Fax | 718-461-9515
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Provider Business Mailing Address
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Address Line | 212-12 NORTHER BLVD 3RD FLOOR
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City | BAY SIDE
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State | NY
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Zip | 11361
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Country | US
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Telephone | 718-461-9602
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Fax | 718-461-9515
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MEI PIAO
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Credential |
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Telephone | 718-461-9602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 0950L001
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License Number State | NY
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