Provider Demographics
NPI:1720312838
Name:EXTRACARE HOME HEALTH SERVICES INC
Entity Type:Organization
Organization Name:EXTRACARE HOME HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:Y
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:734-925-1909
Mailing Address - Street 1:2100 W BIG BEAVER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-3406
Mailing Address - Country:US
Mailing Address - Phone:734-925-1909
Mailing Address - Fax:
Practice Address - Street 1:2100 W BIG BEAVER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3406
Practice Address - Country:US
Practice Address - Phone:734-925-1909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health