MEDICARE: THE EXTRAORDINARY KIDS FOUNDATION, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM3000X	Medically Fragile Infants and Children Day Care

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043759244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE EXTRAORDINARY KIDS FOUNDATION, INC

Provider Business Mailing Address
First Line	:	6690 RAINWOOD COVE LN
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-7448
Country	:	US
Telephone Number	:	561-379-5591
Fax Number	:

Provider Business Practice Location Address
First Line	:	1928 LAKE WORTH RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-4228
Country	:	US
Telephone Number	:	561-660-6741
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MADEAN GILZENE
Credential	:
Telephone Number	:	561-660-6741

Provider Enumeration Date	:	02/21/2017
Last Update Date	:	06/24/2021

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