Provider Demographics
NPI:1881846418
Name:EXTREME CARE SERVICES LLC
Entity Type:Organization
Organization Name:EXTREME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MS
Authorized Official - First Name:EVELYN AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSARIO JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-731-3250
Mailing Address - Street 1:5604 TOWN N COUNTRY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-4142
Mailing Address - Country:US
Mailing Address - Phone:813-731-3250
Mailing Address - Fax:313-731-3252
Practice Address - Street 1:5604 TOWN N COUNTRY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-4142
Practice Address - Country:US
Practice Address - Phone:813-731-3250
Practice Address - Fax:313-731-3252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL253Z00000X, 261QH0100X, 311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL39965537OtherAHCA NUMBER