Organization
EXTREME CARE SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. EVELYN AMANDA ROSARIO JACKSON (MGR)
(813) 731-3250
Entity
Organization
Contact information
Practice address
5604 TOWN N COUNTRY BLVD, TAMPA, FL 33615-4142
(813) 731-3250
(313) 731-3252
Mailing address
5604 TOWN N COUNTRY BLVD, TAMPA, FL 33615-4142
(813) 731-3250
(313) 731-3252
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
FL
261QH0100X
Health Service Clinic/Center
—
FL
311ZA0620X
Adult Care Home Facility
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39965537
AHCA NUMBER
FL
Enumeration date
10/14/2008
Last updated
09/09/2013
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