Provider Demographics
NPI:1679810030
Name:EXTENDED HANDS INCORPORATION
Entity type:Organization
Organization Name:EXTENDED HANDS INCORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGENE
Authorized Official - Middle Name:RENATE
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:678-939-8916
Mailing Address - Street 1:PO BOX 2494
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-1950
Mailing Address - Country:US
Mailing Address - Phone:678-939-8916
Mailing Address - Fax:
Practice Address - Street 1:1599 HOLLY RIDGE DR
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-4180
Practice Address - Country:US
Practice Address - Phone:678-939-8916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities