Provider Demographics
NPI:1174793996
Name:X-TREME CARE, LLC
Entity type:Organization
Organization Name:X-TREME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MEI
Authorized Official - Middle Name:
Authorized Official - Last Name:PIAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-461-9602
Mailing Address - Street 1:212-12 NORTHER BLVD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BAY SIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361
Mailing Address - Country:US
Mailing Address - Phone:718-461-9602
Mailing Address - Fax:718-461-9515
Practice Address - Street 1:212-12 NORTHER BLVD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BAY SIDE
Practice Address - State:NY
Practice Address - Zip Code:11361
Practice Address - Country:US
Practice Address - Phone:718-461-9602
Practice Address - Fax:718-461-9515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0950L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04194730Medicaid