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Organization
EXTRAORDINARY HOMECARE LLC
Active
Organization
EXTRAORDINARY HOMECARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THERESA PRICE (CEO)
(706) 814-5712
Entity
Organization
Contact information
Practice address
1116 WINDWOOD ST, EVANS, GA 30809-7452
(706) 814-5712
Mailing address
2801 WASHINGTON RD STE 107-174, AUGUSTA, GA 30909-2355
(864) 651-8664
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
NULL
253Z00000X
In Home Supportive Care Agency
—
NULL
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
343900000X
Non-emergency Medical Transport (VAN)
—
NULL
347C00000X
Private Vehicle
—
NULL
374U00000X
Home Health Aide
—
NULL
374U00000X
Home Health Aide
—
—
385H00000X
Respite Care
—
NULL
Other
Enumeration date
06/05/2019
Last updated
02/19/2021
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