1972180719 NPI number — EXTRA HAND IN-HOME CARE, LLC

Table of content: (NPI 1972180719)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972180719 NPI number — EXTRA HAND IN-HOME CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EXTRA HAND IN-HOME CARE, 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:
1972180719
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8439 WHITE OAK AVE STE 104A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANCHO CUCAMONGA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91730-3860
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-360-2223
Provider Business Mailing Address Fax Number:
909-360-2247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8439 WHITE OAK AVE STE 104A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RANCHO CUCAMONGA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91730-3860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-360-2223
Provider Business Practice Location Address Fax Number:
909-360-2247
Provider Enumeration Date:
03/26/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GAINES
Authorized Official First Name:
HARRY
Authorized Official Middle Name:
ELLIS
Authorized Official Title or Position:
PRESIDENT/MANAGING MEMBER
Authorized Official Telephone Number:
909-360-2223

Provider Taxonomy Codes

  • Taxonomy code: 163WH0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WI0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WW0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 372600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 374U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 376J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 376K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 364700044 . This is a "CALIFORNIA DEPARTMENT OF SOCIAL SERVICES" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 550007839 . This is a "CALIFORNIA DEPARTMENT OF PUBLIC HEALTH" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 7429441 . This is a "MEDI-CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".