Provider Demographics
NPI:1528036753
Name:EXTRAKARE, LLC
Entity Type:Organization
Organization Name:EXTRAKARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:LLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-449-6898
Mailing Address - Street 1:PO BOX 922575
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30010-2575
Mailing Address - Country:US
Mailing Address - Phone:770-449-6898
Mailing Address - Fax:770-449-3336
Practice Address - Street 1:3250 PEACHTREE CORNERS CIR
Practice Address - Street 2:SUITE A
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-5751
Practice Address - Country:US
Practice Address - Phone:770-449-6898
Practice Address - Fax:770-449-3336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA975916385AMedicaid
GA5252200001Medicare NSC