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General NPI Number Information
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NPI Number | 1386216570
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Entity Type | Organization
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Legal Business Name | XTRAORDINARY CARE
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Dates
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Enumeration Date | 07/15/2021
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Last Update Date | 07/15/2021
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Provider Practice Location Address
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Address Line | 1310 IH 10 S STE 210
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City | BEAUMONT
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State | TX
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Zip | 77707-4444
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Country | US
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Telephone | 409-433-7433
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Fax |
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Provider Business Mailing Address
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Address Line | 3910 TREADWAY RD APT 803
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City | BEAUMONT
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State | TX
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Zip | 77706-7137
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Country | US
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Telephone | 409-433-7433
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Fax |
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Authorized Official
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Title or Position | LVN
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Name | MS. CLARISSA JOHNNIE
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Credential |
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Telephone | 409-433-7433
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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 |
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License Number State |
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