Provider Demographics
NPI:1386216570
Name:XTRAORDINARY CARE
Entity Type:Organization
Organization Name:XTRAORDINARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LVN
Authorized Official - Prefix:MS
Authorized Official - First Name:CLARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNNIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-433-7433
Mailing Address - Street 1:3910 TREADWAY RD APT 803
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-7137
Mailing Address - Country:US
Mailing Address - Phone:409-433-7433
Mailing Address - Fax:
Practice Address - Street 1:1310 IH 10 S STE 210
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-4444
Practice Address - Country:US
Practice Address - Phone:409-433-7433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health