Provider Demographics
NPI:1356861314
Name:EXTENDED FAMILY LLC
Entity Type:Organization
Organization Name:EXTENDED FAMILY LLC
Other - Org Name:EXTENDED FAMILY COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:BOUCHER
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:603-430-6863
Mailing Address - Street 1:1000 MARKET ST.
Mailing Address - Street 2:BUILDING 1 SUITE 104
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-3358
Mailing Address - Country:US
Mailing Address - Phone:603-430-6863
Mailing Address - Fax:
Practice Address - Street 1:1000 MARKET ST UNIT 1
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-3358
Practice Address - Country:US
Practice Address - Phone:603-430-6863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health