Provider Demographics
NPI:1740010438
Name:EXTRAORDINARY HOME HEALTH CARE LLC
Entity type:Organization
Organization Name:EXTRAORDINARY HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROATESS
Authorized Official - Middle Name:
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-503-5305
Mailing Address - Street 1:1322 VILLAGE GARDEN DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-1513
Mailing Address - Country:US
Mailing Address - Phone:903-503-5305
Mailing Address - Fax:
Practice Address - Street 1:1322 VILLAGE GARDEN DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-1513
Practice Address - Country:US
Practice Address - Phone:903-503-5305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)