Provider Demographics
NPI:1679154249
Name:XTENDED HANDS HOMECARE
Entity type:Organization
Organization Name:XTENDED HANDS HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORNA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:623-387-0770
Mailing Address - Street 1:1725 W GLENDALE AVE APT 2091
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-8809
Mailing Address - Country:US
Mailing Address - Phone:623-387-0770
Mailing Address - Fax:
Practice Address - Street 1:1725 W GLENDALE AVE APT 2091
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-8809
Practice Address - Country:US
Practice Address - Phone:623-387-0770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-15
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health