Provider Demographics
NPI:1700184918
Name:DDEXTENDED CARE SERVICES
Entity Type:Organization
Organization Name:DDEXTENDED CARE SERVICES
Other - Org Name:DDEXTENDED CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RN
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-987-8408
Mailing Address - Street 1:139 EVAN RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-4022
Mailing Address - Country:US
Mailing Address - Phone:845-987-8408
Mailing Address - Fax:
Practice Address - Street 1:139 EVAN RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-4022
Practice Address - Country:US
Practice Address - Phone:845-987-8408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY625885251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02103804Medicaid
NY1386792497OtherNPI