Provider Demographics
NPI:1417539370
Name:EXTRAORDINARY HOLDINGS CORP.
Entity Type:Organization
Organization Name:EXTRAORDINARY HOLDINGS CORP.
Other - Org Name:EXTRAORDINARY HOLDINGS CORP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:NICKENS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:562-900-7845
Mailing Address - Street 1:4501 CERRITOS AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-4215
Mailing Address - Country:US
Mailing Address - Phone:714-816-5069
Mailing Address - Fax:
Practice Address - Street 1:4501 CERRITOS AVE STE 203
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-4215
Practice Address - Country:US
Practice Address - Phone:562-900-7845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-21
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA194700756OtherHEALTH CARE ORGANIZATION LICENSE NUMBER