Provider Demographics
NPI:1083134738
Name:EXTRA HAND IN-HOME CARE, LLC
Entity Type:Organization
Organization Name:EXTRA HAND IN-HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:ELLIS
Authorized Official - Last Name:GAINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-360-2223
Mailing Address - Street 1:8439 WHITE OAK AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3860
Mailing Address - Country:US
Mailing Address - Phone:909-360-2223
Mailing Address - Fax:909-360-2293
Practice Address - Street 1:8439 WHITE OAK AVE STE 104
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3860
Practice Address - Country:US
Practice Address - Phone:909-360-2223
Practice Address - Fax:909-360-2293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-23
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 251F00000X, 251J00000X, 372600000X, 374U00000X, 376J00000X, 376K00000X, 385HR2050X
CA364700044253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
No385HR2050XRespite Care FacilityRespite CareRespite Care Camp
Provider Identifiers
StateIdentifier IDID TypeIssuer
080126397OtherDUN & BRADSTREET
CA364700044OtherCALIFORNIA DEPTARTMENT OF SOCIAL SERVICES
CA550007839OtherCALIFORNIA DEPARTMENT OF PUBLIC HEALTH