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General NPI Number Information
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NPI Number | 1407700628
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Entity Type | Organization
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Legal Business Name | EXTRA CARE SUPPORT SERVICES LLC
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Dates
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Enumeration Date | 02/24/2026
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Last Update Date | 02/24/2026
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Provider Practice Location Address
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Address Line | 1655 FORT MYER DR
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City | ARLINGTON
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State | VA
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Zip | 22209-3113
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Country | US
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Telephone | 667-200-9215
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Fax |
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Provider Business Mailing Address
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Address Line | 6820 FOUNTAIN PARK DR
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City | GLENN DALE
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State | MD
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Zip | 20769-9485
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Country | US
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Telephone | 667-200-9215
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAMILOLA AJEPE
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Credential |
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Telephone | 667-200-9215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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