Provider Demographics
NPI:1912541400
Name:EXTENDED CARE SERVICES
Entity Type:Organization
Organization Name:EXTENDED CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:NASH
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:262-353-1910
Mailing Address - Street 1:N112W16298 MEQUON RD # 142
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-3306
Mailing Address - Country:US
Mailing Address - Phone:262-353-1910
Mailing Address - Fax:
Practice Address - Street 1:N112W16298 MEQUON RD # 142
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-3306
Practice Address - Country:US
Practice Address - Phone:262-353-1910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health