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General NPI Number Information
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NPI Number | 1588555239
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Entity Type | Organization
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Legal Business Name | EXTRAORDINARY HOME HEALTH CARE LLC
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Dates
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Enumeration Date | 07/11/2025
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 1203 SHADY PINES DR
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City | BEASLEY
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State | TX
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Zip | 77417-1330
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Country | US
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Telephone | 905-503-5305
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1482
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City | MISSOURI CITY
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State | TX
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Zip | 77459-8482
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Country | US
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Telephone | 905-503-5305
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ROATESS REEVES
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Credential | LPN
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Telephone | 903-503-5305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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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 | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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