Provider Demographics
NPI:1720739972
Name:EXTENDED HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:EXTENDED HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BATSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:770-256-9898
Mailing Address - Street 1:823 GARDEN WALK BLVD APT B
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-6256
Mailing Address - Country:US
Mailing Address - Phone:770-256-9898
Mailing Address - Fax:
Practice Address - Street 1:6740 SHANNON PKWY STE 34
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-2058
Practice Address - Country:US
Practice Address - Phone:770-681-0374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-10
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty