Organization
EXTENDACARE LLC
Active
Other names
Extendacare Home Care & Infusion Therapy, ExtendaCare Home Care
Organization subpart
No
Provider details
NPI number
Authorized official
QUANISHA M KING RN BSN (DIRECTOR OF OPERATIONS)
(252) 298-5165
Entity
Organization
Contact information
Practice address
2509 NORTH NASH STREET, B, WILSON, NC 27896
(252) 298-5165
(252) 616-3718
Mailing address
2509 NASH STREET NORTH, STE B, WILSON, NC 27896-9015
(252) 298-5165
(252) 616-3718
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251E00000X
Home Health Agency
—
—
251F00000X
Home Infusion Agency
—
—
251J00000X
Nursing Care Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
385H00000X
Respite Care
—
—
Other
Enumeration date
06/14/2023
Last updated
01/13/2025
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