Organization
XTRA HOMECARE SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PEARL BLACK (CFO)
(864) 527-0466
Entity
Organization
Contact information
Practice address
33 MARKET POINT DR, SUITE 2016, GREENVILLE, SC 29607-5768
(864) 527-0466
(864) 288-9872
Mailing address
PO BOX 25249, GREENVILLE, SC 29616-0249
(864) 527-0466
(864) 288-9872
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
EX1162
—
SC
Enumeration date
12/20/2012
Last updated
11/26/2014
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