MEDICARE: EXTREMELY4 U

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	253Z00000X	In Home Supportive Care Agency
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1922859719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXTREMELY4 U

Provider Business Mailing Address
First Line	:	5555 CONNER ST # 3009
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48213-3448
Country	:	US
Telephone Number	:	313-918-7502
Fax Number	:

Provider Business Practice Location Address
First Line	:	5555 CONNER ST # 3009
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48213-3448
Country	:	US
Telephone Number	:	313-918-7502
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SONYA D THORNTON
Credential	:
Telephone Number	:	313-918-7502

Provider Enumeration Date	:	03/29/2024
Last Update Date	:	06/12/2026

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Directions to “EXTREMELY4 U ” Practice Location

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