Extraordinary Care Home LLC

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

Legal business name

EXTRAORDINARY CARE HOME LLC

Practice address

2020 Crooked Ave
Holmen, WI 54636-8632

Phone

(507) 202-1707

NPI assigned

Jul 13, 2026

Organization subpart

No

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

Authorized official

Name

Libin Mohamed Jimale

Title

Owner

Phone

(507) 202-1707

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1783900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783900800000",
    "number": "1801715826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 CROOKED AVE",
            "city": "HOLMEN",
            "state": "WI",
            "postal_code": "546368632",
            "telephone_number": "507-202-1707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 CROOKED AVE",
            "city": "HOLMEN",
            "state": "WI",
            "postal_code": "546368632",
            "telephone_number": "507-202-1707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXTRAORDINARY CARE HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-07-13",
        "last_updated": "2026-07-13",
        "certification_date": "2026-07-14",
        "status": "A",
        "authorized_official_last_name": "JIMALE",
        "authorized_official_first_name": "LIBIN",
        "authorized_official_middle_name": "MOHAMED",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "507-202-1707"
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Megan Eckstein, PHARMD
• Roy J Eggart, PTA
• Alexiya Nevada Ernst
• McKenna Everson
• Mary J Ewers, OTR
• Annette Faller, MD
• Tabitha Michelle Farr, LCSW, LICSW
• Kristin Gail Ferguson, NP
• Kaitlyn Flaherty, DC
• Marianna Louise Forseth

• Assisted Living Facility (Mental Illness) in Holmen, WI
• Providers in Holmen, WI by specialty
• Assisted Living Facility (Mental Illness) in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.