Provider Demographics
NPI:1609446798
Name:EXTRA CARE FOR THE PALM BEACHES LLC
Entity Type:Organization
Organization Name:EXTRA CARE FOR THE PALM BEACHES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ALT ADMIN/CFO
Authorized Official - Prefix:
Authorized Official - First Name:GERALDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-302-1150
Mailing Address - Street 1:1499 FOREST HILL BLVD STE 117
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-6050
Mailing Address - Country:US
Mailing Address - Phone:561-870-3312
Mailing Address - Fax:
Practice Address - Street 1:1499 FOREST HILL BLVD STE 117
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-6050
Practice Address - Country:US
Practice Address - Phone:561-870-3312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty