Provider Demographics
NPI:1952542797
Name:HOME CARE EXTENDED LLC
Entity Type:Organization
Organization Name:HOME CARE EXTENDED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:LIVINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-447-9403
Mailing Address - Street 1:141 NW SUZANNE TER
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-5617
Mailing Address - Country:US
Mailing Address - Phone:817-447-9403
Mailing Address - Fax:817-447-4789
Practice Address - Street 1:141 NW SUZANNE TER
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-5617
Practice Address - Country:US
Practice Address - Phone:817-447-9403
Practice Address - Fax:817-447-4789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007911253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX007911OtherPAS