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General NPI Number Information
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NPI Number | 1952542797
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Entity Type | Organization
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Legal Business Name | HOME CARE EXTENDED LLC
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Dates
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Enumeration Date | 03/06/2009
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Last Update Date | 03/06/2009
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Provider Practice Location Address
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Address Line | 141 NW SUZANNE TER
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City | BURLESON
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State | TX
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Zip | 76028-5617
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Country | US
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Telephone | 817-447-9403
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Fax | 817-447-4789
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Provider Business Mailing Address
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Address Line | 141 NW SUZANNE TER
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City | BURLESON
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State | TX
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Zip | 76028-5617
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Country | US
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Telephone | 817-447-9403
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Fax | 817-447-4789
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. NORMA FAYE LIVINGSTON
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Credential |
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Telephone | 817-447-9403
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 007911
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License Number State | TX
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