Provider Demographics
NPI:1811650096
Name:LEAGUE OF EXTRAORDINARY CARE
Entity type:Organization
Organization Name:LEAGUE OF EXTRAORDINARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:DESMOND
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-974-5574
Mailing Address - Street 1:5333 N MACARTHUR BLVD APT 3107
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-8776
Mailing Address - Country:US
Mailing Address - Phone:248-974-5574
Mailing Address - Fax:
Practice Address - Street 1:5333 N MACARTHUR BLVD APT 3107
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-8776
Practice Address - Country:US
Practice Address - Phone:248-974-5574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health