Provider Demographics
NPI:1003584319
Name:EXTENDED FAMILY CARE SERVICES
Entity Type:Organization
Organization Name:EXTENDED FAMILY CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HARTESIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWHORN-KEMP
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:318-268-6641
Mailing Address - Street 1:431 DOGWOOD SOUTH LN
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037-8552
Mailing Address - Country:US
Mailing Address - Phone:318-268-6641
Mailing Address - Fax:318-390-2258
Practice Address - Street 1:431 DOGWOOD SOUTH LN
Practice Address - Street 2:
Practice Address - City:HAUGHTON
Practice Address - State:LA
Practice Address - Zip Code:71037-8552
Practice Address - Country:US
Practice Address - Phone:318-268-6641
Practice Address - Fax:318-390-2258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No251E00000XAgenciesHome Health