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Organization
EXTENDED HOME CARE, INC.
Active
Organization
EXTENDED HOME CARE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA M CLARK RN (CEO/SECRETARY OF THE BOARD)
(573) 359-5546
Entity
Organization
Contact information
Practice address
105 RUSSELL ST, HAYTI, MO 63851-1300
(573) 359-2930
(573) 359-1304
Mailing address
105 RUSSELL ST, PO BOX 393, HAYTI, MO 63851-1300
(573) 359-2930
(573) 359-1304
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0003454
SSBG
MO
05
—
268892502
—
MO
Enumeration date
11/15/2005
Last updated
11/12/2021
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