1881846418 NPI number — EXTREME CARE SERVICES LLC

Table of content: (NPI 1881846418)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881846418 NPI number — EXTREME CARE SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EXTREME CARE SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881846418
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5604 TOWN N COUNTRY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33615-4142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-731-3250
Provider Business Mailing Address Fax Number:
313-731-3252

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5604 TOWN N COUNTRY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33615-4142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-731-3250
Provider Business Practice Location Address Fax Number:
313-731-3252
Provider Enumeration Date:
10/14/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ROSARIO JACKSON
Authorized Official First Name:
EVELYN AMANDA
Authorized Official Middle Name:
Authorized Official Title or Position:
MGR
Authorized Official Telephone Number:
813-731-3250

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QH0100X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 311ZA0620X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 39965537 . This is a "AHCA NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".