Provider Demographics
NPI:1952603516
Name:EXTRAHELP INC
Entity type:Organization
Organization Name:EXTRAHELP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANATOLY
Authorized Official - Middle Name:NICKOLAY
Authorized Official - Last Name:LUKYANOV
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:352-474-8492
Mailing Address - Street 1:13200 W NEWBERRY RD APT J50
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-2770
Mailing Address - Country:US
Mailing Address - Phone:352-474-8492
Mailing Address - Fax:352-332-7187
Practice Address - Street 1:1259 MARINA PT APT 301
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-6476
Practice Address - Country:US
Practice Address - Phone:352-474-8492
Practice Address - Fax:352-332-7187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management