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General NPI Number Information
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NPI Number | 1841662616
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Entity Type | Organization
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Legal Business Name | EXTENSION HOME CARE LLC
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Dates
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Enumeration Date | 10/20/2015
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Last Update Date | 10/20/2015
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Provider Practice Location Address
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Address Line | 2132 GAMMA CT
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City | ORANGE PARK
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State | FL
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Zip | 32073-5110
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Country | US
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Telephone | 904-494-8360
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Fax |
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Provider Business Mailing Address
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Address Line | 419A COLLEGE DR SUITE 1
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City | MIDDLEBURG
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State | FL
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Zip | 32068-6508
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | CATHLEEN MERRITT
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Credential |
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Telephone | 904-484-8360
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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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