Provider Demographics
NPI:1821632415
Name:XTREME PERSONAL CARE SERVICES LLC
Entity Type:Organization
Organization Name:XTREME PERSONAL CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMIYYAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-285-6295
Mailing Address - Street 1:16 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017-1704
Mailing Address - Country:US
Mailing Address - Phone:862-285-6295
Mailing Address - Fax:
Practice Address - Street 1:16 LAKE ST
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-1704
Practice Address - Country:US
Practice Address - Phone:862-285-6295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health