Provider Demographics
NPI:1407402787
Name:EXTENSIVE HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:EXTENSIVE HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREEMAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:302-294-6250
Mailing Address - Street 1:280 E MAIN ST STE 112
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-7324
Mailing Address - Country:US
Mailing Address - Phone:302-294-6250
Mailing Address - Fax:302-286-7382
Practice Address - Street 1:280 E MAIN ST STE 112
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-7324
Practice Address - Country:US
Practice Address - Phone:302-696-5511
Practice Address - Fax:302-286-7382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-13
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty