Provider Demographics
NPI:1518597806
Name:SERVING EXTRA CARE LLC
Entity Type:Organization
Organization Name:SERVING EXTRA CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMIKA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-335-5902
Mailing Address - Street 1:2597 LAKE ERMA DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-6085
Mailing Address - Country:US
Mailing Address - Phone:478-335-5902
Mailing Address - Fax:
Practice Address - Street 1:2597 LAKE ERMA DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-6085
Practice Address - Country:US
Practice Address - Phone:478-335-5902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-25
Last Update Date:2020-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health