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Organization
EXTRAORDINARY PRIVATE HOMECARE SERVICES LLC.
Active
Organization
EXTRAORDINARY PRIVATE HOMECARE SERVICES LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THERESA BRONCHELL ISAAC (OWNER)
(478) 274-8787
Entity
Organization
Contact information
Practice address
302 B-1 RAMSEY ST., DUBLIN, GA 31021
(478) 274-8787
(877) 271-3257
Mailing address
PO BOX 1553, DUBLIN, GA 31040-1553
(478) 274-8787
(877) 271-3257
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
087R0792
GA
332B00000X
Durable Medical Equipment & Medical Supplies
087-R-0792
GA
385H00000X
Respite Care
087-R-0792
GA
Other
Enumeration date
12/05/2011
Last updated
03/05/2012
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