Extensions of Living, LLC

Primary specialty

HomemakerTaxonomy code 376J00000X

License

07589517 Issued in MS

Legal business name

EXTENSIONS OF LIVING, LLC

Practice address

301 Humble Ave
Suite 174
Hattiesburg, MS 39401-6365

Phone

(601) 582-4695

Fax

(601) 582-8178

NPI assigned

Jan 11, 2012

Organization subpart

No

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

Authorized official

Name

Miss Vicki Renee Jackson

Title

Director

Phone

(601) 582-4695

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1326240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326240000000",
    "number": "1477823169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 HUMBLE AVE",
            "address_2": "SUITE 174",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394016365",
            "telephone_number": "601-582-4695",
            "fax_number": "601-582-8178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 HUMBLE AVE",
            "address_2": "SUITE 174",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394016365",
            "telephone_number": "601-582-4695",
            "fax_number": "601-582-8178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXTENSIONS OF LIVING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-11",
        "last_updated": "2012-01-11",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "VICKI",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "601-582-4695",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "376J00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Homemaker",
            "state": "MS",
            "license": "07589517",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07628574",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07589517",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Homemaker in Hattiesburg, MS
• Providers in Hattiesburg, MS by specialty
• Homemaker in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2012; 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.