Provider Demographics
NPI:1255582946
Name:EXTENDED FAMILY INC
Entity type:Organization
Organization Name:EXTENDED FAMILY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRICA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOLIVETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-280-2621
Mailing Address - Street 1:201 LEONARD ST
Mailing Address - Street 2:
Mailing Address - City:BREAUX BRIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70517-5199
Mailing Address - Country:US
Mailing Address - Phone:337-507-3819
Mailing Address - Fax:337-332-0072
Practice Address - Street 1:201 LEONARD ST
Practice Address - Street 2:
Practice Address - City:BREAUX BRIDGE
Practice Address - State:LA
Practice Address - Zip Code:70517-5199
Practice Address - Country:US
Practice Address - Phone:337-507-3819
Practice Address - Fax:337-332-0072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA 15114253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care