Provider Demographics
NPI:1235295494
Name:EXTREME ACTIVITIES INC
Entity Type:Organization
Organization Name:EXTREME ACTIVITIES INC
Other - Org Name:WILLOW CREEK ADULT DAY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTON
Authorized Official - Prefix:MR
Authorized Official - First Name:SAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:830-773-2552
Mailing Address - Street 1:2321 HILLCREST BLVD
Mailing Address - Street 2:PO BOX 7100
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-4401
Mailing Address - Country:US
Mailing Address - Phone:830-773-2552
Mailing Address - Fax:830-757-2962
Practice Address - Street 1:808 N BIBB AVE
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-4406
Practice Address - Country:US
Practice Address - Phone:830-773-2552
Practice Address - Fax:830-757-2962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117633261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care