Organization Active NPI

Extended Hands Senior Care LLC

  • Gerontology Nurse Practitioner
  • Fort Worth, TX
National Provider Identifier
1639029580
Registry record updated Jan 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
Legal business name
EXTENDED HANDS SENIOR CARE LLC
Practice address
3425 Sycamore School Rd Ste 101
Fort Worth, TX 76123-3030
Phone
(469) 915-4211
NPI assigned
Jan 30, 2026
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2026

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

Authorized official

Name
Al Berry
Title
Manager
Phone
(469) 915-4211

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LG0600X Primary

Addresses

Primary practice location

3425 Sycamore School Rd Ste 101
Fort Worth, TX 76123-3030

Mailing address

3425 Sycamore School Rd Ste 101
Fort Worth, TX 76123-3030
Phone (469) 915-4211

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260216001974 TX Part B Supplier - Clinic/Group Practice 3274013602 Receives reassigned benefits from 1 practitioner
Practice locations: Fort Worth, TX

National Provider Directory

National Provider Directory

Locations

3425 Sycamore School Rd
Ste 101
Fort Worth, TX 76123
Phone (682) 470-7636

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1769731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769731200000",
    "number": "1639029580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3425 SYCAMORE SCHOOL RD STE 101",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761233030",
            "telephone_number": "469-915-4211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3425 SYCAMORE SCHOOL RD STE 101",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761233030",
            "telephone_number": "469-915-4211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXTENDED HANDS SENIOR CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-01-30",
        "last_updated": "2026-01-30",
        "certification_date": "2026-01-30",
        "status": "A",
        "authorized_official_last_name": "BERRY",
        "authorized_official_first_name": "AL",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "469-915-4211"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.