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General NPI Number Information
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NPI Number | 1851516363
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Entity Type | Organization
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Legal Business Name | EXTENSIONS OF LIVING, L.L.C.
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3370 WINTERGREEN RD
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City | COVE CITY
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State | NC
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Zip | 28523-9204
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Country | US
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Telephone | 252-514-2727
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Fax | 252-514-2770
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Provider Business Mailing Address
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Address Line | 3370 WINTERGREEN RD
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City | COVE CITY
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State | NC
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Zip | 28523-9204
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Country | US
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Telephone | 252-514-2727
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Fax | 252-514-2770
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Authorized Official
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Title or Position | BILLING OFFICER STAFF NURSE
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Name | MONIQUE ALEXANDRIA ROBINSON
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Credential | ADMINISTRATOR
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Telephone | 252-514-2727
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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 | HC2540
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License Number State | NC
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