Provider Demographics
NPI:1932558897
Name:EXTENDED FAMILY SUPPORT
Entity Type:Organization
Organization Name:EXTENDED FAMILY SUPPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:770-693-4995
Mailing Address - Street 1:5077 DALLAS HWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-4508
Mailing Address - Country:US
Mailing Address - Phone:770-693-4995
Mailing Address - Fax:678-909-2840
Practice Address - Street 1:5077 DALLAS HWY
Practice Address - Street 2:SUITE 301
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-4508
Practice Address - Country:US
Practice Address - Phone:770-693-4995
Practice Address - Fax:678-909-2840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health