Provider Demographics
NPI:1205665742
Name:EXTENDED FAMILY HOME CARE AGENCY LLC
Entity type:Organization
Organization Name:EXTENDED FAMILY HOME CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-726-5052
Mailing Address - Street 1:6675 S LEMAY AVE APT A12
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-9440
Mailing Address - Country:US
Mailing Address - Phone:303-726-5052
Mailing Address - Fax:
Practice Address - Street 1:8753 YATES DR STE 200-16
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-6947
Practice Address - Country:US
Practice Address - Phone:303-726-5052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-01
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care