Organization
EXTENDED FAMILY CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ROSE LONNETTE DODGE (ADMINISTRATOR / OWNER)
(931) 952-3499
Entity
Organization
Contact information
Practice address
30 POWERS BRIDGE RD, MANCHESTER, TN 37355-2806
(931) 954-5225
(931) 954-5221
Mailing address
30 POWERS BRIDGE RD, MANCHESTER, TN 37355-2806
(931) 954-5225
(931) 954-5221
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
I000000017110
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
H445690
—
TN
Enumeration date
06/22/2011
Last updated
10/23/2015
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