Organization
EXTENDED HOME CARE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA M CLARK (CEO/SECRETARY OF THE BOARD)
(573) 359-2473
Entity
Organization
Contact information
Practice address
105 RUSSELL ST, HAYTI, MO 63851-1300
(573) 359-2473
(573) 359-1304
Mailing address
105 RUSSELL ST, PO BOX 393, HAYTI, MO 63851-1300
(573) 359-2473
(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
05
—
288892508
—
MO
Enumeration date
03/27/2007
Last updated
11/12/2021
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