Provider Demographics
NPI:1093084519
Name:EXTENDED HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:EXTENDED HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN-BSN
Authorized Official - Phone:478-746-9988
Mailing Address - Street 1:2733 SHERATON DR
Mailing Address - Street 2:BLDG. F-165
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-6826
Mailing Address - Country:US
Mailing Address - Phone:478-746-9988
Mailing Address - Fax:478-746-5111
Practice Address - Street 1:2733 SHERATON DR
Practice Address - Street 2:BLDG. F-165
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-6826
Practice Address - Country:US
Practice Address - Phone:478-746-9988
Practice Address - Fax:478-746-5111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011-R-0034253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care