Extendedliving Healthcare LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

EXTENDEDLIVING HEALTHCARE LLC

Doing business as

EXTENDEDLIVING HEALTHCARE

Practice address

4890 Revere Way
Cumming, GA 30028-6535

Phone

(404) 552-0495

NPI assigned

Jun 10, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Olusegun Rodriguez

Title

Owner

Phone

(404) 552-0495

Specialties & licenses 2

Addresses

Other names 1

• EXTENDEDLIVING HEALTHCARE Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1749513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749513600000",
    "number": "1033004171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4890 REVERE WAY",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300286535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4890 REVERE WAY",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300286535",
            "telephone_number": "404-552-0495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXTENDEDLIVING HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-06-10",
        "last_updated": "2025-06-10",
        "certification_date": "2025-06-10",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ",
        "authorized_official_first_name": "OLUSEGUN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-552-0495",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EXTENDEDLIVING HEALTHCARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.