1619959921 NPI number — EXTENDED FAMILY HOME HEALTH, INC.

Table of content: (NPI 1619959921)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619959921 NPI number — EXTENDED FAMILY HOME HEALTH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EXTENDED FAMILY HOME HEALTH, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619959921
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 RUSSELL ST
Provider Second Line Business Mailing Address:
PO BOX 544
Provider Business Mailing Address City Name:
HAYTI
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63851-1300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-359-2930
Provider Business Mailing Address Fax Number:
573-359-0910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 RUSSELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAYTI
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63851-1300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-359-2930
Provider Business Practice Location Address Fax Number:
573-359-0910
Provider Enumeration Date:
11/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GEE
Authorized Official First Name:
EMILY
Authorized Official Middle Name:
CAROL
Authorized Official Title or Position:
VICE-PRESIDENT
Authorized Official Telephone Number:
573-359-2930

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  606-8 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 334519 . This is a "HEALTHLINK PROVIDER NUMBE" identifier . This identifiers is of the category "OTHER".




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