MEDICARE: EXTENTION OF LIFE CARE, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	171W00000X	Contractor
2	246RP1900X	Phlebotomy Technician
3	372500000X	Chore Provider
4	372600000X	Adult Companion
5	373H00000X	Day Training/Habilitation Specialist
6	3747A0650X	Attendant Care Provider
7	3747P1801X	Personal Care Attendant
8	374U00000X	Home Health Aide
9	376K00000X	Nurse's Aide
10	247200000X	Other Technician

General Provider Information

NPI Number	:	1831047570
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXTENTION OF LIFE CARE, LLC

Provider Business Mailing Address
First Line	:	7850 COMMONS PARK CIR NW # 427
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28027-4423
Country	:	US
Telephone Number	:	704-517-4631
Fax Number	:

Provider Business Practice Location Address
First Line	:	7850 COMMONS PARK CIR NW # 427
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28027-4423
Country	:	US
Telephone Number	:	704-517-4631
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RAYVETTE PAYNE
Credential	:	CMA,CNA,PHLEBOTOMIST
Telephone Number	:	704-517-4631

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	03/18/2026

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Directions to “EXTENTION OF LIFE CARE, LLC ” Practice Location

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