Provider Demographics
NPI:1184989485
Name:THE EXTRA MILE, REGION VIII
Entity type:Organization
Organization Name:THE EXTRA MILE, REGION VIII
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:TURNER-LARRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-388-6088
Mailing Address - Street 1:1900 LAMY LN
Mailing Address - Street 2:STE. C & D
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-9207
Mailing Address - Country:US
Mailing Address - Phone:318-388-6088
Mailing Address - Fax:381-388-6872
Practice Address - Street 1:912 SAINT JOHN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-8440
Practice Address - Country:US
Practice Address - Phone:318-322-5972
Practice Address - Fax:318-322-9875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty