Provider Demographics
NPI:1578005609
Name:EXTRAORDINARY, PERSONALIZED IN HOME CARE
Entity Type:Organization
Organization Name:EXTRAORDINARY, PERSONALIZED IN HOME CARE
Other - Org Name:EPIC IN HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:ROBERTS
Authorized Official - Last Name:KELLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-730-5797
Mailing Address - Street 1:21 LOVE VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-8591
Mailing Address - Country:US
Mailing Address - Phone:803-730-5797
Mailing Address - Fax:
Practice Address - Street 1:21 LOVE VALLEY CT
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036-8591
Practice Address - Country:US
Practice Address - Phone:803-730-5797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCIHCP-0563251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health