Provider Demographics
NPI:1619959921
Name:EXTENDED FAMILY HOME HEALTH, INC.
Entity Type:Organization
Organization Name:EXTENDED FAMILY HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:GEE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:573-359-2930
Mailing Address - Street 1:105 RUSSELL ST
Mailing Address - Street 2:PO BOX 544
Mailing Address - City:HAYTI
Mailing Address - State:MO
Mailing Address - Zip Code:63851-1300
Mailing Address - Country:US
Mailing Address - Phone:573-359-2930
Mailing Address - Fax:573-359-0910
Practice Address - Street 1:105 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:HAYTI
Practice Address - State:MO
Practice Address - Zip Code:63851-1300
Practice Address - Country:US
Practice Address - Phone:573-359-2930
Practice Address - Fax:573-359-0910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO606-8251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
334519OtherHEALTHLINK PROVIDER NUMBE
26-7548Medicare ID - Type UnspecifiedPROVIDER NUMBER