# EXTRAORDINARY HOMECARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659939486
- **Authorized official:** THERESA PRICE (CEO)
- **Authorized official phone:** (706) 814-5712

## Contact information

- **Practice address:** 1116 WINDWOOD ST, EVANS, GA 30809-7452
- **Practice address phone:** (706) 814-5712
- **Mailing address:** 2801 WASHINGTON RD STE 107-174, AUGUSTA, GA 30909-2355
- **Mailing address phone:** (864) 651-8664

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | Yes |
| 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