Extraordinary Private Homecare Services LLC.

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

087R0792 Issued in GA

Legal business name

EXTRAORDINARY PRIVATE HOMECARE SERVICES LLC.

Practice address

302 B-1 Ramsey St.
Dublin, GA 31021

Phone

(478) 274-8787

Fax

(877) 271-3257

NPI assigned

Dec 5, 2011

Organization subpart

No

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

Authorized official

Name

Theresa Bronchell Isaac

Title

Owner

Phone

(478) 274-8787

Specialties & licenses 3

Addresses

Other identifiers 1

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

{
    "created_epoch": "1323043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330905600000",
    "number": "1891063947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1553",
            "city": "DUBLIN",
            "state": "GA",
            "postal_code": "310401553",
            "telephone_number": "478-274-8787",
            "fax_number": "877-271-3257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 B-1 RAMSEY ST.",
            "city": "DUBLIN",
            "state": "GA",
            "postal_code": "31021",
            "telephone_number": "478-274-8787",
            "fax_number": "877-271-3257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXTRAORDINARY PRIVATE HOMECARE SERVICES LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-05",
        "last_updated": "2012-03-05",
        "status": "A",
        "authorized_official_last_name": "ISAAC",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "BRONCHELL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "478-274-8787"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "GA",
            "license": "087R0792",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "GA",
            "license": "087-R-0792",
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "GA",
            "license": "087-R-0792",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1891063947",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 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.