Provider Demographics
NPI:1497261127
Name:EXTENDED HOLDING COMPANY, LLC
Entity Type:Organization
Organization Name:EXTENDED HOLDING COMPANY, LLC
Other - Org Name:EXTENDED AT HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:ACHILARRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-356-4200
Mailing Address - Street 1:370 7TH AVE STE 422
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-0022
Mailing Address - Country:US
Mailing Address - Phone:212-356-4200
Mailing Address - Fax:
Practice Address - Street 1:370 7TH AVE STE 422
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-0022
Practice Address - Country:US
Practice Address - Phone:212-356-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-18
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2659L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04828593Medicaid