Provider Demographics
NPI:1649946088
Name:GODS EXTENDED HANDS HOMEMAKER AND COMPANION SERVICE
Entity type:Organization
Organization Name:GODS EXTENDED HANDS HOMEMAKER AND COMPANION SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KYRIE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-350-1532
Mailing Address - Street 1:3440 HEATHERBEND ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-2087
Mailing Address - Country:US
Mailing Address - Phone:181-735-0153
Mailing Address - Fax:
Practice Address - Street 1:3440 HEATHERBEND ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-2087
Practice Address - Country:US
Practice Address - Phone:181-735-0153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty