Provider Demographics
NPI:1982388393
Name:EXTENDACARE LLC
Entity Type:Organization
Organization Name:EXTENDACARE LLC
Other - Org Name:EXTENDACARE HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:QUANISHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:252-298-5165
Mailing Address - Street 1:2509 NASH STREET NORTH
Mailing Address - Street 2:STE B
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-9015
Mailing Address - Country:US
Mailing Address - Phone:252-298-5165
Mailing Address - Fax:252-616-3718
Practice Address - Street 1:2509 NORTH NASH STREET
Practice Address - Street 2:B
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896
Practice Address - Country:US
Practice Address - Phone:252-298-5165
Practice Address - Fax:252-616-3718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-14
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care