Provider Demographics
NPI:1083656797
Name:EXTRA HOME HEALTH CARE, INC.
Entity Type:Organization
Organization Name:EXTRA HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROWLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-445-1900
Mailing Address - Street 1:5066 BEAVERDAM RD
Mailing Address - Street 2:PO BOX 877
Mailing Address - City:ENFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27823-8700
Mailing Address - Country:US
Mailing Address - Phone:252-445-1900
Mailing Address - Fax:252-445-1901
Practice Address - Street 1:5066 BEAVERDAM RD
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:NC
Practice Address - Zip Code:27823-8700
Practice Address - Country:US
Practice Address - Phone:252-445-1900
Practice Address - Fax:252-445-1901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2483251E00000X
NCHC2957251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601049Medicaid