Provider Demographics
NPI:1356925572
Name:XTREME CARE LLC
Entity type:Organization
Organization Name:XTREME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YUSIMIL
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA NOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-663-6714
Mailing Address - Street 1:18191 NW 68TH AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3998
Mailing Address - Country:US
Mailing Address - Phone:305-364-5214
Mailing Address - Fax:786-332-2359
Practice Address - Street 1:18191 NW 68TH AVE STE 215
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-3998
Practice Address - Country:US
Practice Address - Phone:305-364-5214
Practice Address - Fax:786-332-2359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-12
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30212212OtherAHCA